Sex-specific associations between coronary artery calcification and major adverse cardiovascular events: the NADESICO study

Abstract In a multicenter prospective cohort study of 1187 patients with suspected coronary artery disease (CAD) undergoing coronary computed tomography, mutual relationships among cardiovascular risk factors, coronary artery calcification (CAC), and incident major adverse cardiovascular events (MACE) were examined, with emphasis on sex differences. The final analysis included 978 patients. Cox proportional hazards analyses indicated that smoking, hypertension, diabetes mellitus, and dyslipidemia were associated with MACE in male patients, whereas no risk factors were associated with MACE in female patients. The C-statistics calculated using Framingham risk score for MACE were 0.639 and 0.656 in male and female patients, respectively. In male patients, the C-statistic significantly increased in combined models that added Agatston CAC scores of ≥ 200 to the Framingham risk score (+ 0.056, P = 0.045). In female patients, the C-statistic increased in the model that added an Agatston CAC score of ≥ 400 to Framingham risk score (+ 0.057, P = 0.08). CAC, cardiovascular risk factors, and incident MACE exhibited sex-specific differential associations in patients with suspected CAD. Agatston CAC scores of ≥ 200 in male patients significantly improved the MACE risk prediction over established cardiovascular risk factors, and an Agatston CAC score of ≥ 400 may improve it in female patients.