Coronary artery calcification parameters in patients with coronary heart disease depending on the level of sex hormones
Authors: Tsygankova O , Latyntseva LD , Latyntseva LD , Batluk TI , Batluk TI , Veretyuk VV , Veretyuk VV 
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction. In recent years, a lot of publications have been devoted to calcinosis of the coronary arteries as an important predictor of atherosclerosis. Particular attention is paid to gender-specific aspects of the pathogenesis and pathomorphology of Ischemic heart disease, as well as the levels of major sex hormones in both sexes.

Goal. To study the severity of coronary heart disease in patients with Ischemic heart disease depending on the level of sex hormones, gender characteristics, and age.

Methods. We studied 281 patients (147 women and 134 men) in the age range of 35-65 years with a previous (more than 30 days before inclusion in the study) acute myocardial infarction. The study program included determining the level of sex hormones (women - follicle-stimulating hormone, testosterone; men-testosterone, estradiol). Determination of the degree of coronary artery calcification was evaluated without contrast enhancement using ECG-synchronized MSCT. The volume and weight of total coronary calcium, Ca SCORE (according to the standardized quantitative system for measuring the calcium index-classifications Interpretation Guides, Mayo Clinic (1999) (low, moderate, moderately high, high) was used.

Results. In the female groups (35-55 years old and 56-65 years old), all MSCT indicators of coronary artery calcification are lower than in male peers (p &lt;0.01). For women, CA SCORE at 35-55 years old and 56-65 years old was 71.3 (25% and 75% percentiles, respectively: 22.2; 95.6) and 73.9 (45.1; 116.1), p = 0.247; in men - 144.1 (59.4; 184.8) and 189.1 (94.2; 226.1), p = 0.006. In women of both age groups, hyperandrogenism (testosterone &gt; 3 nmol/l) was characterized by higher values of total coronary calcium (p &lt; 0.001), total coronary calcium (p &lt; 0.01) and coronary calcium index (p &lt; 0.01). Independent direct associations of high testosterone with coronary calcification in women are confirmed by a series of covariance analyzes. Low testosterone in men (&lt;12 nmol/l) was associated with an increase in MSCT indices of coronary artery calcification in the older age category (p &lt; 0.001 for peers with normal androgen). Hyperestrogenia (estradiol ≥0.194 nmol/l) in men in both age groups was characterized by higher values of all indicators of coronary calcification in comparison with men with normal levels of estradiol (p &lt;0.001-0.05), reaching maximum severity in men aged 56- 65 years old with high estradiol. According to the covariance analysis, the main hormone that directly determines Ca SCORE in men with coronary artery disease at the age of 35-65 years was the level of estradiol ≥0.194 nmol/l (p &lt; 0.01).

Conclusion. In the category of patients with myocardial infarction 35-65 years old, the coronary calcium index in women has lower values in comparison with men and does not significantly increase with age, directly depending on the level of total testosterone. In men, Ca Score is positively associated with concentration of estradiol ≥0.194 nmol/l.