Gender-associated differences in plaque phenotype of patients undergoing carotid endarterectomy

Hellings, Willem E.; Pasterkamp, Gérard; Verhoeven, Bart A.N.; Kleijn, Dominique P. V. de; Vries, Jean‐Paul P.M. de; Seldenrijk, Kees A.; Broek, Theo van den; Moll, Frans L.

doi:10.1016/j.jvs.2006.09.051

Cited by 170 publications

(154 citation statements)

References 37 publications

Supporting

Mentioning

131

Contrasting

Unclassified

Order By: Relevance

“…5 The stability of the atherosclerotic plaque may be one of the factors that explain these findings. In line with previous observations showing a more unstable plaque phenotype in men, 6 we observed that PH in the atherosclerotic plaque is more prevalent in men with carotid artery stenosis.…”

Section: Discussionsupporting

confidence: 93%

“…[1][2][3][4][5] One of the possible factors contributing to this sex-associated difference is carotid plaque phenotype, which is significantly more stable in women, especially in asymptomatic patients. 6 Plaque hemorrhage (PH) may lead to accelerated progression of atherosclerotic disease. The leakage of erythrocytes and leukocytes into the atherosclerotic plaque results in an accumulation of atherogenic factors, such as cholesterol, macrophages, and iron, which can contribute to plaque instability.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Sex Is Associated With the Presence of Atherosclerotic Plaque Hemorrhage and Modifies the Relation Between Plaque Hemorrhage and Cardiovascular Outcome

Vrijenhoek

Ruijter

Borst

et al. 2013

Stroke

Self Cite

View full text Add to dashboard Cite

Background and Purpose-Plaque hemorrhage (PH) may lead to accelerated progression of atherosclerotic disease.The presence of local PH in the carotid plaque predicts future cardiovascular events in any vascular territory. We investigated the prevalence of local PH and the predictive value of PH for the occurrence of cardiovascular events in men and women separately. Methods-Atherosclerotic plaques from 1422 patients (969 men, 453 women) who underwent carotid endarterectomy were analyzed histologically for the presence of PH. Patients were monitored for 3 years for cardiovascular events (nonfatal stroke, nonfatal myocardial infarction, vascular death, and vascular intervention). Results-Plaques from men showed a significantly higher prevalence of PH compared with women (67% versus 54%;P<0.001). In 1353 patients with available follow-up data, with a median duration of 2.9 years, 270 events had occurred in men (29%) and 94 in women (22%). Stratified by presence of PH, the event rate was 32% in men with PH versus 23% in men without PH, and 23% in women with PH versus 21% in women without PH. A multivariable Cox proportional hazards model found a significant interaction between sex and PH. PH was significantly associated with events in men (adjusted hazard ratio, 1.9; 95% CI, 1.2-2.8) but not in women (adjusted hazard ratio, 1.0; 95% CI, 0.6-1.7). Conclusions-Atherosclerotic carotid plaques obtained from men reveal a higher prevalence of PH compared with women. Local PH is strongly related to secondary manifestations of cardiovascular disease in men but not in women.

show abstract

Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

Sex Is Associated With the Presence of Atherosclerotic Plaque Hemorrhage and Modifies the Relation Between Plaque Hemorrhage and Cardiovascular Outcome

Vrijenhoek

Ruijter

Borst

et al. 2013

Stroke

Self Cite

View full text Add to dashboard Cite

show abstract

“…Hellings et al carefully analysed histomorphological and inflammatory parameters from intraoperatively removed plaques regarding gender differences. This study reports that plaques in women show higher smooth muscle cell content, contain less fat and are less inflamed, as concluded from lower IL-8 concentration, lower MMP8 activity and lower macrophage content [15]. Clearly, plaques in women are generally more stable than in men.…”

Section: Analysis Of Plaque Morphologymentioning

confidence: 60%

“…The gender-associated differences in plaque morphology are most evident in women with asymptomatic carotid artery stenosis, which may explain why they in particular have lower long-term stroke reduction after CEA [11][12][13][14][15].…”

Section: Analysis Of Plaque Morphologymentioning

confidence: 99%

Gender differences in patients with carotid stenosis

Stoberock¹,

Debus²,

Atlihan³

et al. 2016

Vasa

View full text Add to dashboard Cite

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.

show abstract

“…Similarly, Hellings et al evaluated 450 patients undergoing CEA, and demonstrated that men had higher rates of unstable plaque with more inflammatory features, for example, higher concentration of fat, higher number of macrophages and higher levels of IL-8 and matrix metalloproteinase (MMP)-8 activity [32]. This was regardless of the types of symptoms attributed to the carotid (amaurosis fugax, hemispheric transient ischemic attack or ischemic stroke) or the cardiovascular risk profile [32].…”

Section: Sex Differences In Intermediate Outcomes Of Stroke: Carotid mentioning

confidence: 99%

Reducing Stroke in Women with Risk Factor Management: Blood Pressure and Cholesterol

Baghshomali

Bushnell

2014

Womens Health (Lond Engl)

View full text Add to dashboard Cite

actorStroke is a major cause of death and disability in adults worldwide. Prevention focused on modifiable risk factors, such as hypertension and hyperlipidemia, has shown them to be of significant importance in decreasing the risk of stroke. Multiple studies have brought to light the differences between men and women with regards to stroke and these risk factors. Women have a higher prevalence of stroke, mortality and disability and it has been shown that preventive and treatment options are not as comprehensive for women. Hence, it is of great necessity to evaluate and summarize the differences in gender and stroke risk factors in order to target disparities and optimize prevention, especially because women have a higher lifetime risk of stroke. The purpose of this review is to summarize sex differences in the prevalence of hypertension and hyperlipidemia. In addition, we will review the sex differences in stroke prevention effectiveness and adherence to blood pressure and cholesterol medications, and suggest future directions for research to reduce the burden of stroke in women.

show abstract

Gender-associated differences in plaque phenotype of patients undergoing carotid endarterectomy

Cited by 170 publications

References 37 publications

Sex Is Associated With the Presence of Atherosclerotic Plaque Hemorrhage and Modifies the Relation Between Plaque Hemorrhage and Cardiovascular Outcome

Sex Is Associated With the Presence of Atherosclerotic Plaque Hemorrhage and Modifies the Relation Between Plaque Hemorrhage and Cardiovascular Outcome

Gender differences in patients with carotid stenosis

Reducing Stroke in Women with Risk Factor Management: Blood Pressure and Cholesterol

Contact Info

Product

Resources

About