Gender-related risk of myocardial infarction and subclinical coronary atherosclerosis: a Danish population cohort study.

BACKGROUND AND AIMS: To assess the prevalence of subclinical coronary atherosclerosis and its association with myocardial infarction, death or myocardial infarction, and clinically driven coronary revascularization in asymptomatic women and men in a Danish general population cohort. METHODS: Asymptomatic women (n = 5710, 57%) and men (n = 4293, 43%) >40 years underwent coronary computed tomography angiography. The primary endpoint was myocardial infarction, while secondary endpoints were death or myocardial infarction combined and clinically driven coronary revascularization. RESULTS: From 40 through to >80 years of age, women had less subclinical coronary atherosclerosis than men (P for gender interaction <.0001), both in persons with and without cardiovascular risk factors. Median follow-up was 6.0 years (interquartile range: 3.9-9.5). In individuals with vs without obstructive subclinical coronary atherosclerosis, the adjusted hazard ratio for having a myocardial infarction was 4.1 (95% confidence interval: 1.5-11) in women and 12 (4.6-34) in men (P for gender interaction = .24). Corresponding hazard ratios for death or myocardial infarction combined were 1.9 (1.3-2.9) and 2.7 (1.9-3.9), respectively (P for gender interaction = .30). Finally, corresponding hazard ratios for clinically driven coronary revascularization were 23 (5.2-106) and 34 (11-106), respectively (P for gender interaction = .35). CONCLUSIONS: For the same degree of subclinical coronary atherosclerosis, women may have a lower risk of myocardial infarction than men. These novel findings show that in asymptomatic women and men, the presence of obstructive subclinical coronary atherosclerosis conferred a fourfold and 12-fold risk of myocardial infarction.