Coronary Blood Flow in Women From the CENTURY Trial: Potential Mechanisms for Sex Differences in Coronary Disease.
K Lance Gould, Nils P Johnson, Amanda E Roby et al.
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In 30 seconds
This post hoc analysis of the randomized CENTURY trial compared coronary blood flow (CBF), coronary flow capacity, risk factors, and outcomes in 331 women and 697 men. Despite similar age and measured risk-factor profiles, women had less established coronary artery disease and lower rates of several clinical outcomes. Rest and stress CBF were 33% higher in women across comparable strata. Together with previously reported smaller coronary arteries in women, the authors propose that higher flow may produce greater endothelial shear stress and contribute to sex differences in CAD; this mechanism remains hypothetical.
Key findings
- Rest and stress coronary blood flow were 33% higher in women than men across comparable age, body mass index, risk-factor, and treatment strata.
- Women had approximately half the rates of all-cause death, death or myocardial infarction, revascularization, and major adverse cardiac events compared with men.
- Women had less established CAD, lower coronary artery calcium, and fewer PET perfusion defects despite similar measured risk factors.
Why it matters
The findings highlight a physiological difference that may help explain why clinically manifest CAD occurs later in women despite comparable measured risk factors. They also underscore that sex-related differences in coronary anatomy and flow may be relevant to understanding disease development and interpreting coronary physiology, while the proposed protective mechanism requires further evidence.
What to keep in mind
This was a post hoc analysis, and the proposed higher endothelial shear stress was inferred by combining CBF findings with previously published artery-size data; it was not directly established as the cause of outcome differences.