Sex Differences in Carotid Plaque and Stenosis

Iemolo, Francesco; Martiniuk, Alexandra; Steinman, David A.; Spence, J. David

doi:10.1161/01.str.0000110981.96204.64

Cited by 134 publications

(94 citation statements)

References 53 publications

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“…A partial explanation may involve the influence of sex hormones 22) . In their study, Iemolo et al 22) found that the prevalence of MetS-associated coronary heart disease in women aged 35 to 54 years was almost the same as that in the control group, whereas in women aged 55 to 74 years and in men aged 35 to 74, this prevalence was about twice that of the control group 23) . In several studies, estrogen was thought to be related to an improvement in traditional risk factors, such as elevated levels of lipoproteins 24,25) .…”

Section: Discussionmentioning

confidence: 99%

Metabolic Syndrome may be a Risk Factor for Early Carotid Atherosclerosis in Women but not in Men

Kawamoto

Tomita

Inoue

et al. 2007

JAT

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Aim: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities and a predictor of both type 2 diabetes mellitus and adverse cardiovascular events. Whether there are gender differences in the association between early atherosclerosis and MetS has not yet been thoroughly elucidated. Methods: The subjects consisted of 388 men aged 64 16 years and 480 women aged 70 13 years. Early atherosclerosis was assessed by carotid intima-media thickness (IMT) on B-mode ultrasonography. Results: Carotid IMT values were significantly greater in both male (P 0.007) and female (P 0.002) subjects with MetS. After adjusting for established risk factors, the difference persisted on a significant level in women (P 0.003), but was weak in men (P 0.013). Multiple regression analysis using IMT as an objective variable, with adjustment for various risk factors as explanatory variables, showed that MetS (P 0.016) was a significant independent contributing factor along with known risk factors only in women. Among the components of MetS, hypertension (P 0.036) and dyslipidemia (P 0.008) had a strong impact on carotid IMT in men, whereas hypertension (P 0.003) ranked first in women. Conclusion: The effect of MetS in early carotid atherosclerosis is more pronounced in women than in men, and the impact of MetS components on carotid IMT differs between men and women.

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Section: Discussionmentioning

confidence: 99%

Metabolic Syndrome may be a Risk Factor for Early Carotid Atherosclerosis in Women but not in Men

Kawamoto

Tomita

Inoue

et al. 2007

JAT

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“…A duplex ultrasound study of 1686 patients with vascular disease, stroke, transitoric ischemic attack or asymptomatic carotid stenosis with a 5-year follow-up showed that plaque area is a stronger predictor for stroke than the degree of stenosis. In general, the incidence of carotid stenosis in men is more often and the plaque area is larger than in women [10]. Assessment of carotid plaques by duplex ultrasound revealed that a high ratio of fat to necrotic core, a thin or ruptured fibrinous cap, plaque haemorrhage and a larger wall thickness all are associated with a higher risk for an ischemic cerebrovascular event.…”

Section: Analysis Of Plaque Morphologymentioning

confidence: 99%

Gender differences in patients with carotid stenosis

Stoberock¹,

Debus²,

Atlihan³

et al. 2016

Vasa

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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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“…With no statically difference between CAS and medically treated group (p>0.05). According to disability as regard MRS at presentation in each group, 8 (26.6%) patients in CAS had MRS 0.22 (73.4) patients had MRS 1-2 and no patients had MRS 3, while in medically treated group 4 (20%) patients had MRS 0, 16 (80%) patients had MRS 1-2 and no patients had MRS 3,with no statically difference between CAS and Medically treated group (p>0.05).As regard NIHSS at presentation, 8 (26.7%) patients in CAS group were normal (NIHSS was 0),7 (23.3%) patients had mild stroke (NIHSS 1-5),15 (50%) patients had moderate stroke (NIHSS 6-15) and no patient had moderate to sever (NIHSS [16][17][18][19][20][21][22][23][24][25] or sever stroke (NIHSS 26-42), while in medically treated group 4 (20%) patients were normal, 7 (35%) patients had mild stroke, 9 (45%) patients had moderate stroke and no patient had moderate to sever or sever stroke. With no statically difference between CAS and medically treated group (p>0.05).…”

Section: Resultsmentioning

confidence: 92%

“…Sex hormones seem to play a funda-mental protective role in women through widespread actions, affecting endothelial function, lipid homeostasis, and cardiovascular risk factor reduction [18]. Moreover, some authors claim that estrogens might have plaque stabilization properties and effects on inflammatory status [19].…”

Section: Discussionmentioning

confidence: 99%