Xinnian Yang, Jiayin Zhang, Yanli Song, Dengqiang Jia, Qingqi Hong, Yiqiang Zhan, Xiang Sean Zhou, Yining Dong, Yining Wang, Dijia Wu, Dinggang Shen
Coronary artery disease poses a significant public health threat, and coronary computed tomography angiography is the preferred imaging modality for diagnosis and risk assessment of coronary artery disease through plaque evaluation. However, understandings of how atherosclerotic characteristics vary by age and sex remains limited due to challenges in manual quantitative plaque assessment. Here, we conducted a retrospective, consecutive, multi-center Chinese cohort study of 16,300 patients undergoing clinically indicated coronary computed tomography angiography that revealed multi-level quantitative patterns of atherosclerosis stratified by age and sex. We found that females experienced a delayed atherosclerosis onset by approximately 20 years compared to males, with plaque burden increasing nonlinearly with age and accelerating more evidently after menopause. The built coronary atlas identified plaque clusters, primarily within proximal segments of major coronary arteries, slightly upstream side branch bifurcations. Our findings provide deeper insights into coronary atherosclerosis in the Chinese population, supporting more tailored prevention strategies. Coronary artery disease is a leading health threat, yet age- and sex-specific plaque patterns remain unclear. Here the authors show, using a 16,300-patient CCTA cohort, that females develop atherosclerosis ~20 years later, accelerating following menopause.