title: Carotid Plaque Morphology Is Significantly Associated With Sex, Age, and History of Neurological Symptoms.
abstract: OBJECTIVE
  The purpose of this study was to analyze the association between morphological characteristics of human carotid plaques and patient's sex, age, and history of neurological symptoms.
  
  
  METHODS
  The study included 763 atherosclerotic plaques from patients treated surgically for carotid stenosis between 2004 and 2013. Histological analyses of carotid plaques were performed to assess the type of plaque (American Heart Association classification), the stability of the plaque, the extent of calcification, inflammation, and neovascularization, as well as the deposition of collagen and elastin. According to the scale of outcome measurement, logistic regression, ordinal regression, and multinomial regression analyses were applied. All results were adjusted for common risk factors of atherosclerosis.
  
  
  RESULTS
  Male sex was associated with more cellularity (odds ratio [OR], 1.56; P=0.003), more inflammatory infiltrates (OR, 1.75; P<0.001), and more neovascularization (OR, 1.47; P=0.010), but less calcification (OR, 0.78; P=0.090). Symptomatic patients were more likely to have a lower amount of elastin (OR, 0.71; P=0.057). Higher age was associated with increased calcification (OR, 1.23; P=0.009). Unstable plaques were found more frequently in symptomatic patients (OR, 1.60; 95% confidence interval, 1.14-2.25; P=0.007). A multinomial regression model revealed that age, sex, and history of neurological symptoms were significantly associated with specific plaque types (P=0.009, P<0.001, and P=0.017, respectively).
  
  
  CONCLUSIONS
  Plaque morphology differed between men and women and varied with age. Certain types of plaques (VI and VI/VII) as well as unstable plaques were significantly associated with a history of neurological symptoms. Thus, individual approaches (eg, in detection of plaque hemorrhage or thin fibrous caps) especially based on sex and age should be considered to identify patients at increased risk of stroke.
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany (C.W., H.W., J.P., P.T., A. Zimmermann, A. Zernecke, A.K., H.-H.E.); DZHK (Deutschez Zentrum für Herz-Kreislauf-Forschung), partner site Munich Heart Alliance, Munich, Germany (J.P., H.-H.E.); and Institute of Clinical Biochemistry and Pathobiochemistry, University Hospital Würzburg, Würzburg, Germany (A. Zernecke).
authors.forename: Carina
authors.initials: C
authors.lastname: Wendorff
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany (C.W., H.W., J.P., P.T., A. Zimmermann, A. Zernecke, A.K., H.-H.E.); DZHK (Deutschez Zentrum für Herz-Kreislauf-Forschung), partner site Munich Heart Alliance, Munich, Germany (J.P., H.-H.E.); and Institute of Clinical Biochemistry and Pathobiochemistry, University Hospital Würzburg, Würzburg, Germany (A. Zernecke).
authors.forename: Heiko
authors.initials: H
authors.lastname: Wendorff
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany (C.W., H.W., J.P., P.T., A. Zimmermann, A. Zernecke, A.K., H.-H.E.); DZHK (Deutschez Zentrum für Herz-Kreislauf-Forschung), partner site Munich Heart Alliance, Munich, Germany (J.P., H.-H.E.); and Institute of Clinical Biochemistry and Pathobiochemistry, University Hospital Würzburg, Würzburg, Germany (A. Zernecke).
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Pelisek
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany (C.W., H.W., J.P., P.T., A. Zimmermann, A. Zernecke, A.K., H.-H.E.); DZHK (Deutschez Zentrum für Herz-Kreislauf-Forschung), partner site Munich Heart Alliance, Munich, Germany (J.P., H.-H.E.); and Institute of Clinical Biochemistry and Pathobiochemistry, University Hospital Würzburg, Würzburg, Germany (A. Zernecke).
authors.forename: Pavlos
authors.initials: P
authors.lastname: Tsantilas
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany (C.W., H.W., J.P., P.T., A. Zimmermann, A. Zernecke, A.K., H.-H.E.); DZHK (Deutschez Zentrum für Herz-Kreislauf-Forschung), partner site Munich Heart Alliance, Munich, Germany (J.P., H.-H.E.); and Institute of Clinical Biochemistry and Pathobiochemistry, University Hospital Würzburg, Würzburg, Germany (A. Zernecke).
authors.forename: Alexander
authors.initials: A
authors.lastname: Zimmermann
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany (C.W., H.W., J.P., P.T., A. Zimmermann, A. Zernecke, A.K., H.-H.E.); DZHK (Deutschez Zentrum für Herz-Kreislauf-Forschung), partner site Munich Heart Alliance, Munich, Germany (J.P., H.-H.E.); and Institute of Clinical Biochemistry and Pathobiochemistry, University Hospital Würzburg, Würzburg, Germany (A. Zernecke).
authors.forename: Alma
authors.initials: A
authors.lastname: Zernecke
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany (C.W., H.W., J.P., P.T., A. Zimmermann, A. Zernecke, A.K., H.-H.E.); DZHK (Deutschez Zentrum für Herz-Kreislauf-Forschung), partner site Munich Heart Alliance, Munich, Germany (J.P., H.-H.E.); and Institute of Clinical Biochemistry and Pathobiochemistry, University Hospital Würzburg, Würzburg, Germany (A. Zernecke).
authors.forename: Andreas
authors.initials: A
authors.lastname: Kuehnl
authors.affiliation: From the Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany (C.W., H.W., J.P., P.T., A. Zimmermann, A. Zernecke, A.K., H.-H.E.); DZHK (Deutschez Zentrum für Herz-Kreislauf-Forschung), partner site Munich Heart Alliance, Munich, Germany (J.P., H.-H.E.); and Institute of Clinical Biochemistry and Pathobiochemistry, University Hospital Würzburg, Würzburg, Germany (A. Zernecke). hheckstein@web.de.
authors.forename: Hans-Henning
authors.initials: HH
authors.lastname: Eckstein
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D003094:Collagen / Q000378:metabolism; D003430:Cross-Sectional Studies; D004549:Elastin / Q000378:metabolism; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000473:pathology*; D058226:Plaque, Atherosclerotic / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D012737:Sex Factors; D061205:Vascular Calcification / Q000473:pathology*
chemical_list: D003094:Collagen; D004549:Elastin
keywords: age factors; atherosclerosis; carotid stenosis; sex