Sex Differences in Carotid Atherosclerosis: A Systematic Review and Meta-Analysis

Abstract

BACKGROUND: Over the last decades, several individual studies on sex differences in carotid atherosclerosis have been performed covering a wide range of plaque characteristics and including different populations. This systematic review and meta-analysis aims to summarize previously reported results on sex differences in carotid atherosclerosis and present a roadmap explaining next steps needed for implementing this knowledge in clinical practice. METHODS: We systematically searched PubMed, Embase, Web of Science, Cochrane Central, and Google Scholar for eligible studies including both male and female participants reporting prevalence of imaging characteristics of carotid atherosclerosis and meta-analyzed these studies. Studies had to report at least the following: (1) calcifications; (2) lipid-rich necrotic core; (3) intraplaque hemorrhage; (4) thin-or-ruptured fibrous cap; (5) plaque ulceration; (6) degree of stenosis; (7) plaque size; or (8) plaque inflammation. We prespecified which imaging modalities had to be used per plaque characteristic and excluded ultrasonography. RESULTS: We included 42 articles in our meta-analyses (ranging from 2 through 23 articles per plaque characteristic). Men had more frequently a larger plaque compared to women and, moreover, had more often plaques with calcifications (odds ratio=1.57 [95% CI, 1.23–2.02]), lipid-rich necrotic core (odds ratio=1.87 [95% CI, 1.36–2.57]), and intraplaque hemorrhage (odds ratio=2.52 [95% CI, 1.74–3.66]), or an ulcerated plaque (1.81 [95% CI, 1.30–2.51]). Furthermore, we found more pronounced sex differences for lipid-rich necrotic core in symptomatic opposed to asymptomatic participants. CONCLUSIONS: In this systematic review and meta-analysis, we demonstrate convincing evidence for sex differences in carotid atherosclerosis. All kinds of plaque features—plaque size, composition, and morphology—were more common or larger in men compared to women. Our results highlight that sex is an important variable to include in both study design and clinical-decision making. Further investigation of sex-specific stroke risks with regard to plaque composition is warranted.

Ophthalmic artery stenosis on three-dimensional rotational angiography: interrater agreement, prevalence, and risk factors

“…18 10 Female sex was associated with 2.7 times increased odds of ophthalmic artery stenosis in the current study. This is an interesting finding, as men are more likely to have high-grade extracranial carotid stenosis, 19 and there is no difference in the prevalence of intracranial atherosclerotic disease between the sexes. 20 However, females have a higher risk of other non-atherosclerotic extracranial and intracranial vasculopathies, such as intracranial aneurysm disease, 21 moyamoya disease, 22 and fibromuscular dysplasia, 23 raising the possibility that ophthalmic artery stenosis has a non-atherosclerotic pathology.…”

Contemporary burden of atrial fibrillation in mechanical thrombectomy stroke patients in the United States

“…AF in women carry a higher AIS risk compared to men 20 but this excess risk may not be very apparent in individuals <75 years of age 21 . Other major causes of LVO AIS such as extracranial carotid atherosclerosis 22 may be more prominent etiologies of AIS in men compared to women. All these factors may potentially contribute to the higher AF prevalence noted in the very elderly women with MT compared to similar aged men.…”

Understanding the Relationship Between Vascular Smooth Muscle Cell Function and the Efficacy of Acupuncture in Treating Cerebral Ischemic Stroke: A Preclinical Meta-Analysis and Systematic Review

“…Additionally, it is widely acknowledged that there exists a disparity in terms of sex regarding CIS incidence, treatment benefit, and complication rate. 88 The study primarily focused on male rats, prompting the need for future neuroscience community research to include both male and female rats. Lastly, the understanding of the comprehensive mechanisms underlying acupuncture is limited, as there are other signaling pathways (such as RhoA/ROCK, ERK, and P38MAPK pathways) involved in vasomotion mechanisms.…”