title: Age- and gender-related changes in plaque composition in patients with acute coronary syndrome: the PROSPECT study.
abstract: OBJECTIVE
  Atherosclerosis accelerates with increasing age; however, young women presenting with acute coronary syndromes (ACS) have adverse outcomes compared to men despite less obstructive coronary artery disease. We sought to evaluate the in vivo plaque characteristics and composition of untreated non-culprit lesions (NCL) at two ages (<65 years old and ≥65 years old) in patients with ACS and examine the effect of sex in both groups.
  
  
  RESULTS
  Untreated NCLs from 697 patients with ACS were imaged with greyscale and radiofrequency intravascular ultrasound. NCL plaque morphology, burden, composition, and major adverse cardiac events (MACE) were analysed in both age groups, and a posterior sex-based sub-analysis was performed. Plaques from patients ≥65 (n=974) vs. <65 (n=2,275) years old were longer (median 12.62 mm vs. 10.75 mm, p=0.008) and had greater plaque burden (48.2% vs. 47.5%, p=0.001), necrotic core (12.5% vs. 11.0%, p=0.001) and dense calcium (5.7% vs. 4.0%, p<0.0001). Men <65 years old also had a greater number of fibroatheromas (3.0 vs. 2.0, p=0.007) and NCLs per patient (5.0 vs. 4.0, p=0.004) with larger plaque volumes (47.7% vs. 46.8%, p=0.04), and fewer fibrotic plaques (2.2% vs. 4.4%, p=0.03) than women in the same age group. These sex differences were not observed in patients ≥65 years old. The incidence of MACE during median 3.4 year follow-up did not significantly differ according to age in this study.
  
  
  CONCLUSIONS
  The current study confirms in vivo that, with aging, plaque burden, necrotic core and calcium content increase significantly. Moreover, gender-specific differences in the extent and composition of coronary plaque are present in patients <65 years (but not ≥65 years) of age, which suggest differential sex-related effects on atherosclerosis development and progression.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Ruiz-García
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Ecaterina
authors.initials: E
authors.lastname: Cristea
authors.forename: Tony G
authors.initials: TG
authors.lastname: Farah
authors.forename: Rui
authors.initials: R
authors.lastname: Teles
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Botker
authors.forename: Barry
authors.initials: B
authors.lastname: Templin
authors.forename: Zhen
authors.initials: Z
authors.lastname: Zhang
authors.forename: Bernard
authors.initials: B
authors.lastname: de Bruyne
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D000367:Age Factors; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D017023:Coronary Angiography; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000000981:diagnostic imaging / Q000473:pathology; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D012307:Risk Factors; D012737:Sex Factors; D018084:Ultrasonography, Interventional