Sex differences in patients with asymptomatic carotid atherosclerotic plaque: in vivo 3.0-T magnetic resonance study.

Abstract

BACKGROUND AND PURPOSE:

Stroke prevention with carotid endarterectomy in asymptomatic men with carotid stenosis is greater than in women. Men have a higher incidence of stroke <75 years of age. Sex differences in plaque characteristics may help explain this, because several plaque features, including a thin/ruptured fibrous cap, larger lipid-rich/necrotic core, and hemorrhage, are associated with increased risk of stroke. We hypothesize that MRI carotid plaque features will demonstrate sex differences indicative of higher-risk plaque in men.

METHODS:

One hundred thirty-one patients (men, 67; women, 64) with >or=50% asymptomatic carotid stenosis on duplex ultrasound were included. Two blinded reviewers interpreted multicontrast MRI. Presence of a thin/ruptured fibrous cap, plaque components (lipid-rich/necrotic core, hemorrhage, and calcification), and percent component volume were documented. The associations between sex and individual plaque characteristics were examined using logistic and linear regression models (2-part models) controlling for demographic characteristics and MR angiographic findings.

RESULTS:

Presence of a thin/ruptured fibrous cap (48% versus 17%, adjusted OR=4.41, P<0.01) and lipid-rich/necrotic core (73% versus 50%, adjusted OR=3.66, P=0.01) were more common in men. There was a trend for more highly prevalent hemorrhage (33% versus, 17%, adjusted OR=2.15, P=0.07) in men. Calcification was not significantly associated with sex. Men demonstrated larger volumes of percent lipid-rich/necrotic core (median, 7.7% versus 3.2%, P=0.01), and percent hemorrhage (median, 6.1% versus 1.5%, P<0.01).

CONCLUSIONS:

In patients with asymptomatic >or=50% carotid stenosis by duplex ultrasound, men had higher-risk plaque features compared with women after controlling for potential confounders. These findings may help explain sex differences in stroke incidence and prevention.

• Authors: Hideki Ota, Mathew J Reeves, David C Zhu, Arshad Majid, Alonso Collar, Chun Yuan, J Kevin DeMarco
• Journal: Stroke (Stroke) Vol. 41 Issue 8 Pg. 1630-5 (Aug 2010) ISSN: 1524-4628 [Electronic] United States
• PMID: 20616325 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Atherosclerosis (diagnostic imaging, pathology)
• Carotid Arteries (diagnostic imaging, pathology)
• Carotid Stenosis (diagnostic imaging, pathology)
• Female
• Hemorrhage (diagnostic imaging, pathology)
• Humans
• Image Processing, Computer-Assisted
• Linear Models
• Magnetic Resonance Imaging
• Male
• Odds Ratio
• Sex Characteristics
• Sex Factors
• Ultrasonography