Full Papers
Sex and menopausal status differences in coronary calcification and extra-coronary computed tomography findings in inflammatory arthritis
M.A. Mohammed1, E. Nguyen2, S. Shahab3, W. Wu4, S. Akhtari5, P. Harvey6, L. Eder7, B. Kuriya8
- Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Canada.
- Department of Medical Imaging, University of Toronto, Canada.
- Department of Medicine, Division of Cardiology, Women’s College Hospital, University of Toronto; and Division of Rheumatology, Women’s College Department, University of Toronto, Canada.
- Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Canada.
- Department of Medicine, Division of Cardiology, Women’s College Hospital, University of Toronto, Canada.
- Department of Medicine, Division of Cardiology, Women’s College Hospital, University of Toronto, Canada.
- Division of Rheumatology, Women’s College Department, University of Toronto, ON, Canada.
- Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Canada. bindee.kuriya@sinaihealth.ca
CER19900
Full Papers
Received: 10/03/2026
Accepted : 11/05/2026
In Press: 12/09/2026
Abstract
OBJECTIVES:
Patients with inflammatory arthritis (IA) have increased cardiovascular risk. Coronary artery calcium (CAC) scoring by computed tomography (CT) detects early coronary disease. While sex and menopause influence CVD risk, their impact on CT findings in IA is unclear. In this study we aimed to describe the extent and distribution of CT-detected cardiovascular abnormalities in IA, including coronary calcification, and potential differences due to sex and menopause.
METHODS:
This was a cross-sectional analysis of IA patients aged >40 years without prior CVD. The primary outcome was CAC score by the Agatston method (0, 1–99, ≥100); secondary outcomes included calcified plaque distribution and other CT-detected abnormalities such as aortic enlargement. Multivariable logistic regression assessed associations with post-menopausal status.
RESULTS:
Among 597 IA patients, 31% were male (mean age 57.3), 14% pre-menopausal female (46.3 years), and 55% post-menopausal female (61.9 years). Spondyloarthropathy was more common in males (70%); RA was more common in females (70%). CAC ≥100 occurred in 28% of males, 20% of post-, and 1.4% of pre-menopausal females (p<0.0001). Post-menopausal females had more aortic calcification (44%), aortic enlargement (23%, all p≤0.001), while males had more left main, circumflex and right coronary calcification (p≤0.001). Post-menopausal females had lower odds of elevated CAC vs. males (OR 0.29, 95% CI 0.17–0.49). Independent predictors of CAC ≥100 included older age, higher CRP, and smoking. Post-menopausal associations with aortic changes were not significant after adjustment.
CONCLUSIONS:
Sex and menopausal status are associated with coronary and extra-coronary CT abnormalities in IA patients. These observations underscore the need to acknowledge and better understand sex-related differences in CVD risk expression, as traditional and disease-related risk factors may not confer equivalent risk in females and males.
