Sex-related differences in carotid plaque features and inflammation.
OBJECTIVE
Severe carotid stenosis is a frequent cause of stroke in both men and women. Whereas several sex-related comparisons are available on coronary atherosclerosis, there are few data appraising gender-specific features of carotid plaques. We aimed to systematically compare the pathology and inflammatory features of carotid plaques in men vs women.


METHODS
Carotid plaque specimens were collected from patients undergoing surgical endarterectomy for asymptomatic or symptomatic carotid stenosis. Histologic analysis was performed, as well as measurements of plaque composition and inflammation.


RESULTS
A total of 457 patients were included (132 women, 325 men). Baseline analyses showed a greater prevalence of hypercholesterolemia, hypertension, and former smoking status in women, despite a higher Framingham Heart Score in men (all P < .05). Women had a lower prevalence of thrombotic plaques, smaller percentage area of necrotic core, and hemorrhage extension (all P < .05). Plaque inflammation analysis showed a lower concentration of inflammatory and, in particular, of macrophage foam cells in the plaque cap of women (both P < .05). These differences were, however, no longer significant at multivariable analysis, including several baseline features, such as symptom status and stenosis severity.


CONCLUSIONS
Carotid plaques seem significantly different in women and men, but the main drivers of such pathologic differences are baseline features, including stenosis severity and symptom status.
Division of Cardiology, Cardiac Catheterization Laboratory, University of Tor Vergata, Rome, Italy.
Giuseppe
G
Sangiorgi
Sara
S
Roversi
Giuseppe
G
Biondi Zoccai
Maria Grazia
MG
Modena
Francesca
F
Servadei
Arnaldo
A
Ippoliti
Alessandro
A
Mauriello
D000368:Aged; D058070:Asymptomatic Diseases; D002339:Carotid Arteries / Q000276:immunology / Q000473:pathology* / Q000601:surgery; D016893:Carotid Stenosis / Q000453:epidemiology / Q000276:immunology / Q000473:pathology* / Q000601:surgery; D016009:Chi-Square Distribution; D016894:Endarterectomy, Carotid; D005260:Female; D005487:Foam Cells / Q000473:pathology; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D007249:Inflammation / Q000453:epidemiology / Q000276:immunology / Q000473:pathology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis; D058226:Plaque, Atherosclerotic; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012384:Rome / Q000453:epidemiology; D012720:Severity of Illness Index; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D013927:Thrombosis / Q000453:epidemiology / Q000473:pathology