Sex Differences in Plaque Composition and Morphology Among Symptomatic Patients With Mild-to-Moderate Carotid Artery Stenosis
van Dam-Nolen, Dianne H K; van Egmond, Nina C M; Dilba, Kristine; Nies, Kelly; van der Kolk, Anja G; Liem, Madieke I; Kooi, M Eline; Hendrikse, Jeroen; Nederkoorn, Paul J; Koudstaal, Peter J; van der Lugt, Aad; Bos, Daniel
(2022) Stroke, volume 53, issue 2, pp. 370 - 378
(Article)
Abstract
BACKGROUND AND PURPOSE: Incidence of ischemic stroke differs between men and women, with substantially higher rates in men. The underlying mechanism of this difference remains poorly understood but may be because of differences in carotid atherosclerosis. Using an in-depth imaging-based approach, we investigated differences between carotid plaque composition and morphology
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in male and female patients with stroke, taking into account differences in total plaque burden. Additionally, we investigated all possible within-artery combinations of plaque characteristics to explore differences between various plaque phenotypes. METHODS: We included 156 men and 68 women from the PARISK (Plaque At Risk) study, a prospective cohort study of patients with recent ischemic cerebrovascular symptoms and <70% ipsilateral carotid stenosis. Plaque characteristics (intraplaque hemorrhage [IPH], lipid-rich necrotic core [LRNC], calcifications, thin-or-ruptured fibrous cap, ulcerations, total plaque volume) were assessed with magnetic resonance imaging and multidetector-row computed tomography angiography. We used multivariable logistic and linear regression analyses to assess sex differences in plaque characteristics. RESULTS: We found significant difference in total plaque volume between men and women (β=22.9 mm 3 [95% CI, 15.4-30.5]; mean volume in men 1399±425 mm 3, in women 1011±242 mm 3). Additionally, men were more likely to have IPH (odds ratio [OR]=2.8 [95% CI, 1.3-6.3]; IPH proportion in men 49%, in women 16%) and LRNC (OR=2.4 [95% CI, 1.2-4.7]; LRNC proportion in men 73%, in women 41%) even after adjustment for total plaque volume. We found no sex-specific differences in plaque volume-corrected volumes of IPH, LRNC, and calcifications. In terms of coexistence of plaque characteristics, we found that men had more often a plaque with coexistence of calcifications, LRNC, and IPH (OR=2.7 [95% CI, 1.2-7.0]), with coexistence of thin-or-ruptured fibrous cap/ulcerations, LRNC, and IPH (OR=2.4 [95% CI, 1.1-5.9]), and with coexistence of all plaque characteristics (OR=3.0 [95% CI, 1.2-8.6]). CONCLUSIONS: In symptomatic patients with mild-to-moderate carotid stenosis, men are more likely to have a high-risk carotid plaque with IPH and LRNC than women, regardless of total plaque burden. Men also have more often a plaque with multiple vulnerable plaque components, which could comprise an even higher stroke risk.
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Keywords: Aged, Brain Ischemia/etiology, Calcinosis/epidemiology, Carotid Artery Diseases/complications, Carotid Stenosis/epidemiology, Cerebral Hemorrhage/epidemiology, Cohort Studies, Computed Tomography Angiography, Cost of Illness, Female, Humans, Magnetic Resonance Angiography, Male, Middle Aged, Necrosis, Phenotype, Plaque, Atherosclerotic/epidemiology, Prospective Studies, Risk Assessment, Sex Factors, Carotid stenosis, Hemorrhage, Atherosclerosis, Sex characteristics, Lipid, Computed tomography angiography, Magnetic resonance imaging, Clinical Neurology, Cardiology and Cardiovascular Medicine, Advanced and Specialised Nursing, Research Support, Non-U.S. Gov't, Multicenter Study, Journal Article
ISSN: 0039-2499
Publisher: Lippincott Williams and Wilkins
Note: Funding Information: This research was supported by the Dutch Heart Foundation and performed within the framework of the Center for Translational Molecular Medicine ( www.ctmm.nl ), project PARISK (Plaque At RISK; grant number 01C-202). Publisher Copyright: © 2022 The Authors. Stroke is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.
(Peer reviewed)