By Matthew E. Fink, MDLouis and Gertrude Feil Professor and Chair, Department of Neurology, Associate Dean for Clinical Affairs, New York Presbyterian/Weill Cornell Medical College
SOURCE: Van Dam-Nolen DHK, van Egmond NCM, Dilba K, et al. Sex differences in plaque composition and morphology among symptomatic patients with mild-to-moderate carotid artery stenosis. Stroke 2022;53:370-378.
The incidence of ischemic stroke is higher in men than women, although the total number of cases is higher in women because of population differences. The mechanisms for these differences are uncertain, but investigators in the Netherlands investigated the differences between atherosclerotic plaque burden and plaque morphology between men and women who had recent ischemic stroke symptoms and less than 70% ipsilateral carotid artery stenosis. Plaque characteristics were studied by magnetic resonance imaging and computed tomography angiography. They were categorized based on specific characteristics, such as intraplaque hemorrhage, lipid-rich necrotic core, calcifications, ulcerations, and total plaque volume. This work was performed as part of the PARISK (Plaque At Risk) study.
Study subjects included 156 men and 68 women followed prospectively. The investigators found significant differences in mean total plaque volume between men and women — men had 1,399 mm2 and women had 1,011 mm2. Men were more likely to have intraplaque hemorrhage and lipid-rich necrotic cores with coexistence of calcifications. Men also were more likely to have thin or ruptured fibrous caps or ulcerations in their atherosclerotic plaques. In summary, men were found to have high-risk atherosclerotic plaques in the carotid arteries more often than women.
