Evidence map›Paper›PMID 30212857›Full record

ArticleEuropean heart journal2018

Sex differences in calcified plaque and long-term cardiovascular mortality: observations from the CAC Consortium.

Leslee J Shaw, James K Min, Khurram Nasir, Joe X Xie, Daniel S Berman, Michael D Miedema, Seamus P Whelton, Zeina A Dardari, Alan Rozanski, John Rumberger and 4 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in European heart journal, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 116 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
116citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

116 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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  8. Women's heart and echocardiography.Journal of cardiovascular imaging · 2026
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56 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors.

Leslee J ShawEmory University School of Medicine, 1462 Clifton Rd NE, Room 529, Atlanta, GA, USA.
James K MinDepartment of Radiology and Medicine, Weill Cornell Medical College, 413 E. 69th St, Suite 108, New York, NY, USA.
Khurram NasirCardiology & Center for Outcomes Research and Evaluation, Yale New Haven Hospital, Yale University, 1 Church Street, Suite 200, New Haven, CT, USA.
Joe X XieEmory University School of Medicine, 1462 Clifton Rd NE, Room 529, Atlanta, GA, USA.
Daniel S BermanDepartments of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai, 8700 Beverly Blvd, Los Angeles, CA, USA.
Michael D MiedemaCardiovascular Prevention, Minneapolis Heart Institute Foundation, Minneapolis Heart Institute, 920 East 28th Street, Suite 600, Minneapolis, MN, USA.
Seamus P WheltonJohns Hopkins Ciccarone Center for Prevention of Heart Disease, Blalock 524D1, 600 N Wolfe St. Baltimore, MD, USA.
Zeina A DardariJohns Hopkins Ciccarone Center for Prevention of Heart Disease, Blalock 524D1, 600 N Wolfe St. Baltimore, MD, USA.
Alan RozanskiDepartment of Medicine, St. Luke's Roosevelt Hospital Center, 1111 Amsterdam Ave, New York, NY, USA.
John RumbergerPrinceton Longevity Center, Princeton Forrestal Village, 136 Main Street, Princeton, NJ, USA.
C Noel Bairey MerzDepartments of Imaging and Medicine and the Smidt Heart Institute, Cedars-Sinai, 8700 Beverly Blvd, Los Angeles, CA, USA.
Mouaz H Al-MallahCardiac Sciences Department, King Abdul-Aziz Cardiac Center, Mail Code: 1413, Riyadh, Saudia Arabia.
Matthew J BudoffCardiology, Los Angeles Biomedical Research Center, 1124 W. Carson St., RB-2 Torrance, CA, USA.
Michael J BlahaJohns Hopkins Ciccarone Center for Prevention of Heart Disease, Blalock 524D1, 600 N Wolfe St. Baltimore, MD, USA.

Funding

NHLBI NIH HHS L30 HL110027
6 · The paper itself

Abstract

Aims: Pathologic evidence supports unique sex-specific mechanisms as precursors for acute cardiovascular (CV) events. Current evidence on long-term CV risk among women when compared with men based on measures of coronary artery calcium (CAC) remains incomplete. Methods and results: A total of 63 215 asymptomatic women and men were enrolled in the multicentre, CAC Consortium with median follow-up of 12.6 years. Pooled cohort equation (PCE) risk scores and risk factor data were collected with the Agatston score and other CAC measures (number of lesions and vessels, lesion size, volume, and plaque density). Cox proportional hazard models were employed to estimate CV mortality (n = 919). Sex interactions were calculated. Women and men had average PCE risk scores of 5.8% and 9.1% (P < 0.001). Within CAC subgroups, women had fewer calcified lesions (P < 0.0001) and vessels (P = 0.017), greater lesion size (P < 0.0001), and higher plaque density (P = 0.013) when compared with men. For women and men without CAC, long-term CV mortality was similar (P = 0.67), whereas detectable CAC was associated with 1.3-higher hazard for CV death among women when compared with men (P < 0001). Cardiovascular mortality was higher among women with more extensive, numerous, or larger CAC lesions. The relative hazard for cardiovascular disease (CVD) mortality for women and men was 8.2 vs. 5.1 for multivessel CAC, 8.6 vs. 5.9 for ≥5 CAC lesions, and 8.5 vs. 4.4 for a lesion size ≥15 mm3, respectively. Additional explorations revealed that women with larger sized and more numerous CAC lesions had 2.2-fold higher CVD mortality (P < 0.0001) as compared to men. Moreover, CAC density was not predictive of CV mortality in women (P = 0.51) but was for men (P < 0.001), when controlling for CAC volume and cardiac risk factors. Conclusion: Our overall findings support that measures beyond the Agatston score provide important clues to sex differences in atherosclerotic plaque and may further refine risk detection and focus preventive strategies of care.

Indexed as

Cardiovascular DiseasesPlaque, AtheroscleroticVascular CalcificationAdultAgedAged, 80 and overFemaleFollow-Up StudiesHumansMaleMiddle AgedPrognosisRisk FactorsSex Distribution

Identifiers

PMID30212857
PMCPMC6209852

What OpenQuestion holds

Textmetadata
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.