Sex-specific differences in the anatomical localization and severity of coronary artery disease: differential impact of conventional cardiovascular risk factors.

BACKGROUND: Sex differences in coronary artery disease (CAD) are well recognized. Whether conventional cardiovascular risk factors (CVRFs) exert differential effects on anatomical localization and stenosis severity on coronary arteries (CA) remains uncertain. We aimed to evaluate sex-specific associations between major CVRFs and CA involvement. METHODS: We analyzed 978 patients undergoing coronary angiography (CAG) between 2017-2023. Sex, age, hypertension (HT), diabetes mellitus (DM), history of CAD (HCAD), smoking, Syntax scores (SS), lipid parameters and creatinine levels were assessed. Segment-based coronary involvement was evaluated using correlation and multivariable regression analyses. RESULTS: Women were older (p < 0.001), had higher rates of HT (p = 0.001), DM (p = 0.026) and higher total cholesterol (p = 0.001), LDL-C (p = 0.001) and HDL-C levels (p = 0.001). In contrast HCAD (p = 0.001), smoking (p = 0.009) and SS (p < 0,01) were higher in men. HT was associated with circumflex (Cx) (p = 0.029) and right coronary artery (RCA) (p = 0.002) involvement in women; with proximal left anterior descending artery (LAD) (p = 0.024) involvement in men. DM showed significant associations with LAD (p = 0.001), 1st diagonal (Dg) (p = 0.003), Cx: (p = 0.001) and RCA (p = 0.001) territories in women. HCAD was associated with proximal LAD (p = 0.013), CX (p = 0.006) and RCA (p = 0.016) in men; proximal LAD (p = 0.047), CX (p = 0.014) and RCA (p = 0.009) in women. Lipid parameters had no association with CA involvement in either sex after adjustment. Creatinine levels were associated with RCA and CX involvement in women and with LMCA and proximal LAD territories in men. CONCLUSION: CVRFs exert sex-specific effects on CA, highlighting the importance of sex aware risk stratification in CAD.