Sex Differences in the Association between Inflammation and Ischemic Heart Disease

Background  Inflammation plays a fundamental role in mediating all stages of atherosclerosis. Given the higher prevalence of inflammatory rheumatologic conditions in women and the female propensity towards worse cardiovascular outcomes, refined strategies are needed to better identify the high-risk female cardiovascular phenotype. Objectives  This article aims to assess sex-specific links between inflammatory processes and the development and progression of ischemic heart disease. Patients and Methods  The relationship between vertebral bone marrow metabolism—a marker of inflammation—and myocardial injury was retrospectively assessed in 294 patients (28.6% women, mean age: 66.9 ± 10.0 years) who underwent 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET) and 99m Tc-tetrofosmin single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). Results  A significant increase in 18 F-FDG bone marrow uptake was observed in women with impaired myocardial perfusion (SPECT-MPI) as compared to women with normal myocardial perfusion (standardized uptake value [SUV]: 2.2 ± 1.2 vs. 1.7 ± 0.5, p  = 0.013), while no such difference was observed in men (SUV: 1.6 ± 0.8 vs. 1.6 ± 0.4, p  = 0.372). Furthermore, a significant inverse correlation between left ventricular ejection fraction (LVEF) and bone marrow metabolism was seen in women ( r  = –0.229, p  = 0.037), but not in men ( r  = –0.075, p  = 0.289). Accordingly, in women, but not in men, bone marrow activity was identified as an independent predictor of both, reduced LVEF ( β -coefficient, –4.537; p  = 0.040) and impaired myocardial perfusion (β-coefficient, 0.138; p  = 0.014). Conclusion  A strong link between bone marrow metabolism and impaired myocardial function and perfusion was observed in women, but not in men. Our data suggest that novel biomarkers of inflammation might help to identify women at risk for ischemic cardiomyopathy and to tailor disease management to the female cardiovascular phenotype.