Coronary Blood Flow in Women From the CENTURY Trial: Potential Mechanisms for Sex Differences in Coronary Disease (JIMG November 2026)-Article: Coronary Blood Flow in Women From the CENTURY Trial: Potential Mechanisms for Sex Differences in Coronary Disease

Article: Coronary Blood Flow in Women From the CENTURY Trial: Potential Mechanisms for Sex Differences in Coronary Disease

Back to course

Pdf Summary

This post hoc analysis of the CENTURY trial compared coronary physiology and outcomes in 331 women and 697 men with similar age, body mass index, major risk factors, cumulative risk scores, and treatment response. Participants underwent quantitative PET imaging, with outcomes followed for up to 14 years.<br /><br />Despite comparable risk profiles, women had less established coronary artery disease (CAD), less coronary calcium, and fewer PET perfusion abnormalities. They also had lower rates of death, death or myocardial infarction, revascularization, and major adverse cardiovascular events—often about half the rates observed in men. Women’s coronary blood flow was 33% higher at rest and during stress across comparable age, body-size, risk-factor, and treatment groups.<br /><br />The authors propose that this higher flow, combined with prior reports that women’s coronary arteries are about 10% smaller, could produce substantially greater endothelial shear stress (estimated at 82% higher). They hypothesize that this may help protect against atherosclerosis and contribute to women’s later onset and lower burden of CAD. However, shear stress was not directly measured, and the estimate relies on combining trial flow data with coronary-size findings from other studies.<br /><br />Because this was a post hoc, single-center analysis not designed to test sex-specific mechanisms, the findings are hypothesis-generating rather than definitive. The authors call for prospective studies measuring blood flow and artery size in the same participants. The results nonetheless highlight the importance of rigorous, individualized risk-factor prevention for women as well as men.

Meta Tag

Concept CENTURY Trial

Concept Coronary Artery Disease

Concept Coronary Flow

Concept Positron Emission Tomography

Concept Coronary Flow Capacity

Keywords

CENTURY trial

coronary physiology

women

men

PET imaging

coronary artery disease

myocardial infarction

major adverse cardiovascular events

endothelial shear stress

atherosclerosis

CENTURY Trial

Coronary Artery Disease

Coronary Flow

Positron Emission Tomography

Coronary Flow Capacity