title: Impact of gender on the density of intraplaque neovascularization: a quantitative contrast-enhanced ultrasound study.
abstract: OBJECTIVE
  Atherosclerosis is the main underlying cause of the majority of cardiovascular events. Although cardiovascular diseases (CVD) are a major challenge in both males and females, gender specific differences in the prevalence of CVD have been observed. This may indicate that there are differences in the development of atherosclerosis between males and females. The presence of intraplaque neovessels (IPN) is an imaging marker for plaque vulnerability. The aim of this study was to investigate the impact of gender on IPN.
  
  
  METHODS
  A total of 159 patients with ≥1 cardiovascular risk factor were included in this prospective study (mean age 56.9±8.7 years, 47% females). Patients had no symptoms of carotid atherosclerotic disease. All patients underwent a standard carotid ultrasound examination in conjunction with contrast-enhanced ultrasound (CEUS). The presence of atherosclerotic plaques was assessed according to the Mannheim consensus. IPN was assessed using a visual grading scale and semi-automated quantification software.
  
  
  RESULTS
  Subclinical atherosclerosis was detected using standard carotid ultrasound and CEUS in 64 females (86%) and in 79 males (93%) (p=0.177). The mean atherosclerotic plaque sizes were not significantly different (p=0.068). Semi-automated quantification of IPN demonstrated that females had significant more IPN compared to males (p<0.05). After adjustment for clinical variables this association remained significant (p<0.05).
  
  
  CONCLUSIONS
  In this population at increased risk for CVD, females had significantly more IPN compared to males. This suggests that the females had a more vulnerable atherosclerotic plaque type.
authors: Dept. of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; Dept. of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Stijn C H
authors: SCH
authors: van den Oord
authors: Dept. of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Jurgen
authors: J
authors: van der Burg
authors: Dept. of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Zeynettin
authors: Z
authors: Akkus
authors: Dept. of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Johan G
authors: JG
authors: Bosch
authors: Dept. of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Ron T
authors: RT
authors: van Domburg
authors: Division of Pharmacology, Vascular and Metabolic Diseases, Dept. of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Eric J G
authors: EJG
authors: Sijbrands
authors: Dept. of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Antonius F W
authors: AFW
authors: van der Steen
authors: Dept. of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: a.schinkel@erasmusmc.nl.
authors: Arend F L
authors: AFL
authors: Schinkel
mesh_terms: D000886:Anthropometry; D058070:Asymptomatic Diseases; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015897:Comorbidity; D003287:Contrast Media; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging* / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology; D010743:Phospholipids; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012727:Sex Characteristics; D013459:Sulfur Hexafluoride; D018615:Ultrasonography, Doppler, Color; D018617:Ultrasonography, Doppler, Pulsed; D014711:Vertebral Artery / Q000000981:diagnostic imaging
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: Atherosclerosis; Carotid ultrasound; Contrast-ultrasound; Gender differences; Intraplaque neovascularization