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Gender-related differences in carotid plaque features: focus on instability and inflammation

Gender-related differences in carotid plaque features: focus on instability and inflammation. Giuseppe Biondi Zoccai, MD University of Modena and Reggio Emilia, Modena, Italy

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Gender-related differences in carotid plaque features: focus on instability and inflammation

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  1. Gender-related differences in carotid plaque features: focus on instability and inflammation Giuseppe Biondi Zoccai, MD University of Modena and Reggio Emilia, Modena, Italy On behalf of Giuseppe Sangiorgi, Sara Roversi, Francesca Servadei, Doriana Liotti, Luigi Giusto Spagnoli, Alessandro Mauriello, Maria Grazia Modena

  2. BACKGROUND • Severe carotid stenosis is a frequent cause of atherothrombotic stroke in both men and women. • Several sex-related comparisons are available on coronary plaque features, suggesting that males have higher thrombotic burden and females a more severe inflammatory substrate. • However, there are few data appraising gender-specific features of atherosclerotic carotid plaques.

  3. GOAL • We aimed to systematically compare the pathology of carotid plaques in males versus females, with a specific emphasis on features of thrombosis and inflammation.

  4. METHODS • Carotid plaque specimens were collected from patients undergoing surgical thromboendoarterectomy (TEA) for asymptomatic (>80% diameter) or symptomatic (>50% diameter) carotid stenosis. • Standard pathologic analyses were performed, as well as sophisticated measurements for plaque hemorrhage, inflammation and foam cells.

  5. RESULTS • A total of 457 patients were included (132 women, 325 men). • Baseline analyses showed a greater prevalence of hypercholesterolemia and hypertension in women, and higher prevalence of current smoking, despite a raised Framingham Heart score in men (all p<0.05). • Women had a lower prevalence of thrombotic plaques, and smaller percentage area of necrotic core and hemorrhage extension (all p<0.05).

  6. RESULTS • Plaque inflammation analysis showed a lower concentration of inflammatory and foam cells in the plaque cap of females (both p<0.05). • Even at multivariable analysis adjusting for smoking status, hypercholesterolemia, hypertension, Framingham Heart Score, plaque classification, percentage area of necrotic lipid core, hemorrhage extension, women had a significantly lower concentration of foam cells and/or lymphocytes in the cap (p=0.032).

  7. BASELINE FEATURES

  8. PLAQUE PATHOLOGY

  9. PLAQUE PATHOLOGY

  10. PLAQUE INFLAMMATION

  11. MULTIVARIABLE ANALYSIS* *exploring the association between gender and plaque inflammation features AND adjusting for all variables associated at bivariate analyses with gender with p<0.10: smoking status, hypercholesterolemia, hypertension, Framingham Heart Score, plaque classification, thrombotic plaque, percentage area of necrotic lipid core, hemorrhage extension, R2 was computed using as gender as the only independent variable; female gender was coded as 2, and male gender as 1

  12. CONCLUSIONS • Carotid plaques are significantly different in women and men. • In contrast to findings observed in coronary vessels, females have a lower degree of inflammation and thrombosis, and more frequently stable plaques. • Further studies are warranted to demonstrate whether such gender-related differences in carotid pathology may have implications for the clinical management and revascularization of patients with carotid artery disease.

  13. Thank you for your attentionFor any correspondence: gbiondizoccai@gmail.comFor these and further slides on these topics feel free to visit the metcardio.org website:http://www.metcardio.org/slides.html

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