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Sex Differences in Symptomatic Carotid Artery Atherosclerosis: A Chinese Atherosclerosis Risk Evaluation (CARE-II) Study1Radiology, Peking University First Hospital, Beijing, China, 2Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China, 3Department of Radiology, University of Washington, Seattle, WA, United States
Synopsis
The results of this multicenter study ( including 13 hospitals and medical centres across China) demonstrated that, in Chinese patients with recent ischemic cerebrovascular events, males developed higher risk of atherosclerotic plaques carotid arteries than females. The different constituent ratios of traditional risk factors, especially smoking, may contribute to the sex differences in carotid high-risk plaques.
Introduction
To investigate the sex differences in carotid artery plaque characteristics determined by MRI in patients with recent ischemic cerebrovascular events in Chinese population.Methods
A total of 567 patients (males, 404; females, 163) with recent cerebrovascular symptoms and atherosclerotic plaque were enrolled from a multicenter study of CARE-II which aims to investigate the prevalence of high-risk plaque (HRP) in Chinese stroke patients. All patients underwent the carotid MR vessel wall imaging on 3.0T MR scanners. The plaque features of symptomatic carotid arteries were evaluated and compared. The morphology of carotid arteries including lumen area, wall area, total vessel area, percent wall volume, and maximum wall thickness was measured. Presence/absence of calcification, lipid-rich/necrotic core (LRNC), intraplaque hemorrhage (IPH), and fibrous cap rupture (FCR) were identified. Presence/absence of HRP, defined as plaque with IPH, FCR, or %LRNC >40%, was also identified. The differences in above plaque characteristics between male and female patients were determined. Logistic regression was utilized to assess the association between sex and HRP.Results
Clinical characteristics of study population are summarized in Table 1. Both plaque morphology and compositions of carotid arteries were significantly different between male and female patients and male patients more likely had HRP (all p <0.01) (Table 2). Sex was found to be significantly associated with HRP before (OR, 3.01; 95% CI, 1.76-5.15; p<0.001) and after adjusted for body mass index, hypertension, diabetes, coronary heart disease, TC, HDL and LDL (OR, 2.78; 95% CI, 1.60-4.80; p<0.001). When smoking was also adjusted together with above confounding factors, the association was not statistical significant (OR, 1.68; 95% CI, 0.87-3.24; p=0.12).Discussion
The results of this multicenter study showed that, in Chinese population, males developed higher risk of HRP than females. However, Sex was not significantly associated with HRP, when smoking with other traditional risk factors were adjusted in the multivariable model. In contrast, other studies demonstrated that sex differences were found in patients with asymptomatic carotid atherosclerotic plaque1, 2. Regional differences and the differences in the methodology and database selection should be taken into consideration for the outcome discrepancy.Conclusions
In Chinese patients with recent ischemic cerebrovascular events, males developed higher risk of atherosclerotic plaques carotid arteries than females. The different constituent ratios of traditional risk factors, especially smoking, may contribute to the sex differences in carotid high-risk plaques.Acknowledgements
No acknowledgement found.References
1. Ota H, Reeves MJ, Zhu DC, et al. Sex differences of high-risk carotid atherosclerotic plaque with less than 50% stenosis in asymptomatic patients: an in vivo 3T MRI study. AJNR American journal of neuroradiology. 2013; 34 (5): 1049-1055.
2.Ota H, Reeves MJ, Zhu DC, et al. Sex differences in patients with asymptomatic carotid atherosclerotic plaque: in vivo 3.0-T magnetic resonance study. Stroke.2010; 41(8): 1630-1635.
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