title: Gender differences in outcome of conservatively treated patients with asymptomatic high grade carotid stenosis.
abstract: OBJECTIVE
  Gender differences are currently becoming increasingly recognized as an important prognostic factor in patients with atherosclerotic disease. We investigated gender-related differences in vascular outcome and mortality of asymptomatic patients with high-grade internal carotid artery (ICA) stenosis.
  
  
  METHODS
  We enrolled 525 consecutive patients (325 males with a median age of 72 years and 200 females with a median age of 75 years) from a single center registry who were initially treated conservatively with respect to a neurologically asymptomatic > or =70% ICA stenosis. Patients were followed-up for a median of 38 months (interquartile range, 18 to 65) for major adverse cardiovascular, cerebral, and peripheral vascular events (MACE: combined end point including myocardial infarction, stroke, [partial] limb amputation, and death), vascular mortality, and all-cause mortality.
  
  
  RESULTS
  Cumulative MACE-free survival rates in males and females at 1, 3, and 5 years were 83%, 65%, 48% versus 85%, 73%, and 67% (P=0.004), respectively. Adjusted hazard ratios for MACE, vascular mortality, and all-cause mortality for males were 1.96 (P=0.016), 2.48 (P<0.001), and 1.70 (P=0.007) as compared with females, irrespective of age, vascular risk factors, comorbidities, and the individual risk status estimated by the American Society of Anesthesiologists (ASA) score.
  
  
  CONCLUSIONS
  Male patients with high-grade carotid artery stenosis are at a considerably higher risk for poor outcome than their female counterparts. In particular, the risk for fatal vascular events is substantially increased in males.
authors.affiliation: Department of Angiology, Medical University Vienna, Austria.
authors.forename: Petra
authors.initials: P
authors.lastname: Dick
authors.forename: Camillo
authors.initials: C
authors.lastname: Sherif
authors.forename: Schila
authors.initials: S
authors.lastname: Sabeti
authors.forename: Jasmin
authors.initials: J
authors.lastname: Amighi
authors.forename: Erich
authors.initials: E
authors.lastname: Minar
authors.forename: Martin
authors.initials: M
authors.lastname: Schillinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000175:diagnosis* / Q000473:pathology; D002343:Carotid Artery, Internal / Q000473:pathology*; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012306:Risk; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis; D013997:Time Factors; D016896:Treatment Outcome