Abstract：
OBJECTIVE: Women are believed to be protected from coronary heart disease (CHD) by the effects of estrogen but detailed studies on the vessel wall level are missing. We aimed to measure sex differences in atherosclerosis during the premenopausal and postmenopausal periods directly at the coronary arteries.
METHODS: We analyzed statistics for sex differences in CHD mortality in Finland in 2020. Coronary atherosclerosis was measured using computer-assisted morphometry in 10-year age groups of 185 white Caucasian women and 515 men from the Tampere Sudden Death Study.
RESULTS: CHD mortality was rare in both women and men before 50 years of age. After 50 years of age, male mortality increased rapidly, with women reaching equal levels in the oldest age groups. In the autopsy series, there were no differences in fatty streak, fibrotic or calcified plaque areas, nor in the plaque area or stenosis percentage in coronary arteries between premenopausal women and men in the same age group. The plaque area remained 25 % smaller in both coronaries in postmenopausal women aged 51-70 years compared to men. In the oldest postmenopausal group (≥70 years), plaque area reached the level of men. In the postmenopausal period, coronary stenosis in the left anterior descending (LAD) artery remained lower among women.
CONCLUSIONS: We did not detect any major sex-difference in coronary atherosclerosis in the premenopausal period when women are considered to be protected from CHD. However, in line with CHD mortality statistics, postmenopausal women showed a slower speed of coronary atherosclerosis development compared to men.
METHODS: We analyzed statistics for sex differences in CHD mortality in Finland in 2020. Coronary atherosclerosis was measured using computer-assisted morphometry in 10-year age groups of 185 white Caucasian women and 515 men from the Tampere Sudden Death Study.
RESULTS: CHD mortality was rare in both women and men before 50 years of age. After 50 years of age, male mortality increased rapidly, with women reaching equal levels in the oldest age groups. In the autopsy series, there were no differences in fatty streak, fibrotic or calcified plaque areas, nor in the plaque area or stenosis percentage in coronary arteries between premenopausal women and men in the same age group. The plaque area remained 25 % smaller in both coronaries in postmenopausal women aged 51-70 years compared to men. In the oldest postmenopausal group (≥70 years), plaque area reached the level of men. In the postmenopausal period, coronary stenosis in the left anterior descending (LAD) artery remained lower among women.
CONCLUSIONS: We did not detect any major sex-difference in coronary atherosclerosis in the premenopausal period when women are considered to be protected from CHD. However, in line with CHD mortality statistics, postmenopausal women showed a slower speed of coronary atherosclerosis development compared to men.
摘要：
目的：女性被认为可以通过雌激素的作用预防冠心病（CHD），但缺乏关于血管壁水平的详细研究。我们旨在直接测量绝经前和绝经后冠状动脉动脉粥样硬化的性别差异。
方法：我们分析了2020年芬兰CHD死亡率性别差异的统计数据。在坦佩雷猝死研究中，使用计算机辅助形态计量学对185名白人女性和515名男性的10岁年龄组进行了冠状动脉粥样硬化测量。
结果：冠心病死亡率在50岁以前的女性和男性中都是罕见的。50岁以后,男性死亡率迅速上升,妇女在年龄最大的年龄组达到同等水平。在尸检系列中，脂肪条纹没有差异，纤维化或钙化斑块区域，在同一年龄段的绝经前女性和男性之间，冠状动脉的斑块面积或狭窄百分比也没有。与男性相比，年龄在51-70岁的绝经后女性的两个冠状动脉中的斑块面积仍然小25％。在年龄最大的绝经后组（≥70岁），斑块面积达到男性水平。在绝经后，左前降支（LAD）动脉的冠状动脉狭窄在女性中仍然较低。
结论：在绝经前期，当女性被认为可以预防冠心病时，我们没有发现冠状动脉粥样硬化的任何主要性别差异。然而,符合冠心病死亡率统计，与男性相比,绝经后女性的冠状动脉粥样硬化发展速度较慢.
方法：我们分析了2020年芬兰CHD死亡率性别差异的统计数据。在坦佩雷猝死研究中，使用计算机辅助形态计量学对185名白人女性和515名男性的10岁年龄组进行了冠状动脉粥样硬化测量。
结果：冠心病死亡率在50岁以前的女性和男性中都是罕见的。50岁以后,男性死亡率迅速上升,妇女在年龄最大的年龄组达到同等水平。在尸检系列中，脂肪条纹没有差异，纤维化或钙化斑块区域，在同一年龄段的绝经前女性和男性之间，冠状动脉的斑块面积或狭窄百分比也没有。与男性相比，年龄在51-70岁的绝经后女性的两个冠状动脉中的斑块面积仍然小25％。在年龄最大的绝经后组（≥70岁），斑块面积达到男性水平。在绝经后，左前降支（LAD）动脉的冠状动脉狭窄在女性中仍然较低。
结论：在绝经前期，当女性被认为可以预防冠心病时，我们没有发现冠状动脉粥样硬化的任何主要性别差异。然而,符合冠心病死亡率统计，与男性相比,绝经后女性的冠状动脉粥样硬化发展速度较慢.
