This article analyses if and to what extent gender differences exist in abdominal aortic aneurysm (AAA) therapy. For this purpose Medline (PubMed) was searched from January 1999 to January 2018. Keywords were: "abdominal aortic aneurysm", "gender", "prevalence", "EVAR", and "open surgery of abdominal aortic aneurysm". Regardless of open or endovascular treatment of abdominal aortic aneurysms, women have a higher rate of complications and longer hospitalizations compared to men. The majority of studies showed that women have a lower survival rate for surgical and endovascular treatment of abdominal aneurysms after both elective and emergency interventions. Women receive less surgical/interventional and protective medical treatment. Women seem to have a higher risk of rupture, a lower survival rate in AAA, and a higher rate of complications, regardless of endovascular or open treatment. The gender differences may be due to a higher age of women at diagnosis and therapy associated with higher comorbidity, but also because of genetic, hormonal, anatomical, biological, and socio-cultural differences. Strategies for treatment in female patients must be further defined to optimize outcome.
PrevalenceAccording to the "North American Symptomatic Carotid Artery Trial" (NASCET) a significant stenosis of the internal carotid artery is defined as a loss of lumen of at least 50 %. A distinction is made between moderate (50 -70 %) and high-grade stenosis (≥ 70 %).In a meta-analysis of 29 studies involving 22,636 patients, the pooled prevalence of moderate stenosis was 4.2 % (95 % CI 3.1 -5.7 %). In a meta-analysis of 4 studies with 6518 patients, the prevalence of high-grade stenosis was 1.7 % (95 % CI 0.7 -3.9 %) [4].Carotid stenosis is more common in men than in women: 7 -9 % of men > 65 years-old have at least a 50 % stenosis compared to 5 -7 % of age-matched women [4,5]. In a meta-analysis of 8 studies, the prevalence in patients < 70 years-old was 4.8 % (95 % CI 3.1 -7.3 %) for men and 2.2 % (95 % CI 0.9 -4.9 %) for women [3,4]. In patients > 70 years-old, it was 12.5 % (95 % CI 7.4 -20.3 %) for men, and 6.9 % (95 % CI 4.0 -11.5 %) for women [3,4]. Epidemiology and risk factors for strokeAlthough the prevalence for carotid stenosis is higher in men, the risk of stroke is higher in women. In Western societies, one out of every 5 women and one out of every 6 men will suffer from a stroke during their lifetime [5]. Mul- Review Gender differences in patients with carotid stenosisKonstanze Stoberock 1 , Eike Sebastian Debus 1 , Gülsen Atlihan 1 , Günter Daum 1 , Axel Larena-Avellaneda 1 , Sandra Eifert 2 , and Sabine Wipper 1 1 University Heart Center, Hamburg, Germany 2 University Heart Center, Leipzig, Germany Summary: This overview analyses gender differences in prevalence, epidemiology, risk factors and therapy in patients with carotid stenosis in a systematic review. Ischemic stroke is a leading cause of death in Western society, where about 20% of cases are triggered by a carotid stenosis or occlusion, which occurs more frequently in men than in women. The stroke-protective effect of carotid endarterectomy is greater in men. Men have lower peri-procedural stroke and death rates. Particularly men with carotid stenosis and a life expectancy of at least 5 years benefit from surgical treatment. Also, the recurrence rate of ipsilateral stroke 5 years after initial surgery is lower in men than in women. It is not yet fully clarified whether there are significant gender differences regarding the outcome after endovascular versus surgical treatment. Gender differences in the outcome of carotid artery repair may be caused by biological, anatomical (smaller vessel diameter in women) or hormonal differences as well as a protracted development of atherosclerotic changes in women and different plaque morphology. Moreover, women are on average older at the time of surgery and their surgical treatment is often delayed. To reduce the risk of stroke and to improve treatment outcome especially for women, further research on gender differences and their causes is mandatory and promising.
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