scholarly journals Sex Differences in Plaque Composition and Morphology Among Symptomatic Patients With Mild-to-Moderate Carotid Artery Stenosis

Stroke ◽  
2022 ◽  
Author(s):  
Dianne H.K. van Dam-Nolen ◽  
Nina C.M. van Egmond ◽  
Kristine Dilba ◽  
Kelly Nies ◽  
Anja G. van der Kolk ◽  
...  
Keyword(s):  
Sex Differences ◽  
Carotid Stenosis ◽  
Carotid Plaque ◽  
Plaque Burden ◽  
Multidetector Row Computed Tomography ◽  
Plaque Composition ◽  
Plaque Volume ◽  
Men And Women ◽  
Fibrous Cap ◽  
Significant Difference

Background and Purpose: Incidence of ischemic stroke differs between men and women, with substantially higher rates in men. The underlying mechanism of this difference remains poorly understood but may be because of differences in carotid atherosclerosis. Using an in-depth imaging-based approach, we investigated differences between carotid plaque composition and morphology in male and female patients with stroke, taking into account differences in total plaque burden. Additionally, we investigated all possible within-artery combinations of plaque characteristics to explore differences between various plaque phenotypes. Methods: We included 156 men and 68 women from the PARISK (Plaque At Risk) study, a prospective cohort study of patients with recent ischemic cerebrovascular symptoms and <70% ipsilateral carotid stenosis. Plaque characteristics (intraplaque hemorrhage [IPH], lipid-rich necrotic core [LRNC], calcifications, thin-or-ruptured fibrous cap, ulcerations, total plaque volume) were assessed with magnetic resonance imaging and multidetector-row computed tomography angiography. We used multivariable logistic and linear regression analyses to assess sex differences in plaque characteristics. Results: We found significant difference in total plaque volume between men and women (β=22.9 mm 3 [95% CI, 15.4–30.5]; mean volume in men 1399±425 mm 3 , in women 1011±242 mm 3 ). Additionally, men were more likely to have IPH (odds ratio [OR]=2.8 [95% CI, 1.3–6.3]; IPH proportion in men 49%, in women 16%) and LRNC (OR=2.4 [95% CI, 1.2–4.7]; LRNC proportion in men 73%, in women 41%) even after adjustment for total plaque volume. We found no sex-specific differences in plaque volume-corrected volumes of IPH, LRNC, and calcifications. In terms of coexistence of plaque characteristics, we found that men had more often a plaque with coexistence of calcifications, LRNC, and IPH (OR=2.7 [95% CI, 1.2–7.0]), with coexistence of thin-or-ruptured fibrous cap/ulcerations, LRNC, and IPH (OR=2.4 [95% CI, 1.1–5.9]), and with coexistence of all plaque characteristics (OR=3.0 [95% CI, 1.2–8.6]). Conclusions: In symptomatic patients with mild-to-moderate carotid stenosis, men are more likely to have a high-risk carotid plaque with IPH and LRNC than women, regardless of total plaque burden. Men also have more often a plaque with multiple vulnerable plaque components, which could comprise an even higher stroke risk. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01208025.

Abstract P372: Sex-Differences in Carotid Plaque Composition in Patients With Embolic Stroke of Undetermined Source

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jae W Song ◽  
James E Siegler ◽  
Jesse Thon ◽  
John H Woo ◽  
Brett L Cucchiara
Keyword(s):  
Risk Factors ◽  
Sex Differences ◽  
Ischemic Stroke ◽  
Carotid Plaque ◽  
Vascular Risk Factors ◽  
Embolic Stroke ◽  
Vascular Risk ◽  
Plaque Composition ◽  
Plaque Volume ◽  
Male Sex

Introduction: Non-stenotic carotid plaque may be the cause of ischemic stroke in some patients with embolic stroke of undetermined source (ESUS). We examined sex-differences in carotid plaque composition in patients with ESUS. Methods: A retrospective cohort of anterior circulation acute ischemic stroke patients with CTA head/neck and meeting criteria for ESUS was identified. Carotid artery bifurcations (4cm segment) ipsilateral to the stroke were evaluated using a semi-automated segmentation software to measure total plaque volume and plaque subcomponents (calcium, intraplaque hemorrhage [IPH], and lipid rich necrotic core [LRNC]). Sex-differences in baseline vascular risk factors and plaque subcomponent volumes were tested by Mann-Whitney U tests or students t-tests for continuous variables and Fisher’s exact test for categorical variables. Associations of each plaque subcomponent were tested by multivariate linear regressions. Results: Of 94 patients, 55% were women. Mean age of the cohort was 65 years. Women had higher body mass indices than men (29.2 vs 26.3; p=0.02). There were no other significant differences in age or vascular risk factors between men and women. Overall plaque volume (p=0.001) was significantly greater in men as was the volume of calcification (p<0.001) and IPH (p=0.008) in carotid arteries ipsilateral to the stroke (Figure). No significant difference was detected in LRNC volume by sex (p=0.84). In multivariate analysis, male sex (β=45.9, 95% CI 18.0-73.7, p=0.002) and older age (β=1.85, 95% CI 0.73-3.0, p=0.001) were significantly associated with calcified plaque volume, and male sex (β= 6.7, 95% CI 2.6-10.8, p=0.002) with IPH. Neither age nor sex was significantly associated with LRNC. Conclusions: Sex-differences in carotid plaque composition in ESUS suggest the possibility of a differential contribution of non-stenotic carotid plaque to stroke mechanism in men versus women.

Abstract 16464: Coronary Artery Calcium Score and Incidence of Clinically Significant Carotid Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Aditya Singh ◽  
Tom Stys ◽  
Valerie Bares ◽  
Jeffrey Wilson ◽  
Adam Stys
Keyword(s):  
Coronary Artery ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Coronary Artery Calcium ◽  
Carotid Artery Stenosis ◽  
Coronary Artery Calcium Score ◽  
Calcium Score ◽  
Artery Stenosis ◽  
Plaque Burden ◽  
Significant Difference

Introduction: Coronary artery calcium (CAC) has been found to be associated with coronary artery plaque burden and is a major predictor of coronary heart disease (CHD) events. The data on its role in predicting carotid artery stenosis (CAS) is limited. Methods: Participants age ≥ 18 years with heart screen done from Nov 2008- Feb 2019 were selected and were assessed for documented diagnosis of carotid artery stenosis after their heart screen. Only the most recent heart screen per person and earliest documented CAS was considered. The chi-squared test and Welch’s 2-sample t-test was used to test for significant association between CAS and the nominal variables and mean calcium score respectively. Results: A total of 35,084 patient were screened for CAC score and 1439 (4.1%), were recorded to have a diagnosis of carotid artery stenosis. 53.5% being females and mean age of 63.69±9.31 years. The mean time between heart screen and documented diagnosis of CAS was 1529.4 ± 1211.0 days. The presence of CAS was significantly higher in patients ≥ 60 years (8.5%) as compared to those age <60 years (2%). There was a significant difference in mean CAC score between those with CAS as compared to non- carotid stenosis group (324.2, vs 107.27, p<.0001). In patient with elevated CAC ≥ 100, 9.98% had diagnosis of CAS, as compared to 2.82% in patients with CAC <100, however among patients with diagnosis of CAS 46.6% had elevated CAC ≥ 100. Conclusions: The presence of carotid artery stenosis (CAS) was significantly associated with elevated coronary artery calcium score (≥100) and was significantly higher in patients with age ≥ 60 years, which in correct clinical context is helpful in suspecting CAS.

scholarly journals Sex-Differences in Discontinuation of Statin Treatment in Cancer Patients the Year before Death

2021 ◽  
Vol 14 (4) ◽  
pp. 368
Author(s):  
Gabriella Frisk ◽  
Helena Bergström ◽  
Maria Helde Frankling ◽  
Linda Björkhem-Bergman
Keyword(s):  
Sex Differences ◽  
Advanced Cancer ◽  
Cardiovascular Events ◽  
Statin Treatment ◽  
Men And Women ◽  
Time Points ◽  
Disease Trajectory ◽  
Significant Difference ◽  
History Of ◽  
One Year

Statin treatment is often terminated in patients with advanced cancer but guidelines for statin discontinuation are still lacking. The aim of this study was to investigate sex-differences in time-points of statin discontinuation in patients with advanced cancer. Medical records from 1535 deceased patients enrolled at a Palliative Home Care Unit were reviewed. A total of 149 patients (42 women and 107 men) who were diagnosed with cancer, and were treated with statins one year before death, were identified. Statin treatment was terminated earlier in women than in men, 3.0 months prior to death (IQR 0.88–7.25) as compared to 1.5 months (IQR 0.5–4.0) (p < 0.05), respectively. In a longitudinal analysis there was a significant difference between men and women still on statin treatment at all studied time-points, 9, 6, and 3 months before death (p < 0.05), where women terminated statin treatment earlier in the disease trajectory. Baseline demographics were similar between the sexes except that more men than women had a history of previous cardiovascular events (p < 0.01). However, neither the indication for statin treatment, i.e., primary prevention versus secondary prevention, nor age could explain the sex-difference in statin discontinuation. There was no difference in cardiovascular events or mortality between men and women after statin discontinuation.

scholarly journals Insulin sensitivity in critically ill patients: are women more insulin resistant?

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Vincent Uyttendaele ◽  
J. Geoffrey Chase ◽  
Jennifer L. Knopp ◽  
Rebecca Gottlieb ◽  
Geoffrey M. Shaw ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Sex Differences ◽  
Insulin Sensitivity ◽  
Metabolic Response ◽  
Demographic Data ◽  
Randomised Trial ◽  
Preterm Neonates ◽  
Men And Women ◽  
Increased Risk ◽  
Significant Difference

Abstract Background Glycaemic control (GC) in intensive care unit is challenging due to significant inter- and intra-patient variability, leading to increased risk of hypoglycaemia. Recent work showed higher insulin resistance in female preterm neonates. This study aims to determine if there are differences in inter- and intra-patient metabolic variability between sexes in adults, to gain in insight into any differences in metabolic response to injury. Any significant difference would suggest GC and randomised trial design should consider sex differences to personalise care. Methods Insulin sensitivity (SI) levels and variability are identified from retrospective clinical data for men and women. Data are divided using 6-h blocks to capture metabolic evolution over time. In total, 91 male and 54 female patient GC episodes of minimum 24 h are analysed. Hypothesis testing is used to determine whether differences are significant (P < 0.05), and equivalence testing is used to assess whether these differences can be considered equivalent at a clinical level. Data are assessed for the raw cohort and in 100 Monte Carlo simulations analyses where the number of men and women are equal. Results Demographic data between females and males were all similar, including GC outcomes (safety from hypoglycaemia and high (> 50%) time in target band). Females had consistently significantly lower SI levels than males, and this difference was not clinically equivalent. However, metabolic variability between sexes was never significantly different and always clinically equivalent. Thus, inter-patient variability was significantly different between males and females, but intra-patient variability was equivalent. Conclusion Given equivalent intra-patient variability and significantly greater insulin resistance, females can receive the same benefit from safe, effective GC as males, but may require higher insulin doses to achieve the same glycaemia. Clinical trials should consider sex differences in protocol design and outcome analyses.

scholarly journals Sex Differences in Carotid Plaque Composition in Patients With Embolic Stroke of Undetermined Source

2021 ◽  
Author(s):  
Jae W. Song ◽  
Quy Cao ◽  
James E. Siegler ◽  
Jesse M. Thon ◽  
John H. Woo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sex Differences ◽  
Carotid Plaque ◽  
Negative Control ◽  
Necrotic Core ◽  
Embolic Stroke ◽  
Intraplaque Hemorrhage ◽  
Plaque Composition ◽  
Anterior Circulation ◽  
Calcified Plaque

Background We examined sex differences in nonstenotic carotid plaque composition in patients with embolic stroke of undetermined source (ESUS). Methods and Results Patients with anterior circulation ischemic stroke imaged with neck computed tomographic angiography who met criteria for ESUS or had atrial fibrillation were identified. Patients with atrial fibrillation were included as a negative control. Semiautomated plaque quantification software analyzed carotid artery bifurcations. Plaque subcomponent (calcium, intraplaque hemorrhage [IPH], and lipid rich necrotic core) volumes were compared by sex and in paired analyses of plaque ipsilateral versus contralateral to stroke. Multivariate linear regressions tested for associations. Ninety‐four patients with ESUS (55% women) and 95 patients with atrial fibrillation (47% women) were identified. Men with ESUS showed significantly higher volumes of calcified plaque (63.9 versus 19.6 mm 3 , P <0.001), IPH (9.4 versus 3.3 mm 3 , P =0.008) and a IPH/lipid rich necrotic core ratio (0.17 versus 0.07, P =0.03) in carotid plaque ipsilateral to stroke side than women. The atrial fibrillation cohort showed no significant sex differences in plaque volumes ipsilateral to stroke. Multivariate analyses of the ESUS cohort showed male sex was associated with IPH ipsi (β=0.49; 95% CI, 0.11–0.87) and calcium ipsi (β=0.78; 95% CI, 0.33–1.23). Paired plaque analyses in men with ESUS showed significantly higher calcified plaque (63.9 versus 34.1 mm 3 , P =0.03) and a trend of higher IPH ipsi (9.4 versus 7.5 mm 3 , P =0.73) and lipid rich necrotic core ipsi (59.0 versus 48.4 mm 3 , P =0.94) volumes. Conclusions Sex differences in carotid plaque composition in ESUS suggest the possibility of a differential contribution of nonstenosing carotid plaque as a stroke mechanism in men versus women.

scholarly journals Doppler Ultrasound Monitoring of Echogenicity in Asymptomatic Subcritical Carotid Stenosis and Assessment of Response to Oral Supplementation of Vitamin K2 (PLAK2 Randomized Controlled Trial)

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 229
Author(s):  
Yamume Tshomba ◽  
Domenico Baccellieri ◽  
Niccolò Carta ◽  
Giuseppe Cilli ◽  
Vincenzo Ardita ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Acetylsalicylic Acid ◽  
Carotid Stenosis ◽  
Standard Therapy ◽  
Carotid Plaque ◽  
Controlled Trial ◽  
Vitamin K2 ◽  
Plaque Composition ◽  
Oral Supplementation ◽  
Randomized Controlled

Background: Plaque composition may predict the evolution of carotid artery stenosis rather than its sole extent. The grey scale median (GSM) value is a reproducible and standardized value to report plaque echogenicity as an indirect measure of its composition. We monitored plaque composition in asymptomatic subcritical carotid stenosis and evaluated the effect of an oral modulating calcification factor (vitamin K2). Methods: Carotid plaque composition was assessed by GSM value. Monitoring the effects of standard therapy (acetylsalicylic acid and low–medium dosage statin) (acetylsalicylic acid (ASA) arm) or standard therapy plus vitamins K2 oral supplementation (ASA + K2 arm) over a 12 months period was conducted using an ultrasound scan in a prospective, open-label, randomized controlled trial (PLAK2). Results: Sixty patients on low–medium dosage statin therapy were enrolled and randomized (30 per arm) to either ASA + K2 or ASA alone. Thirty-seven patients (61.6%) showed at 12 months a stable plaque with a mean increase in the GSM value in respect to the baseline of 2.6% with no differences between the two study arms (p = 0.66). Fifteen patients (25%) showed an 8% GSM value reduction respect the baseline with no differences between the two study arms (p = 0.99). At multivariable analysis, the adjusted mean (95% confidence interval) GSM change per month from baseline was greater in the ASA + K2 arm (−0.55 points, p = 0.048) compared to ASA alone (−0.18 points, p = 0.529). Conclusions: Carotid plaque composition monitoring through GSM value represents a laborious procedure. Although its use may not be applied to everyday practice, a specific application consists in evaluating the effect of pharmacological therapy on plaque composition. This 12 months randomized trial showed that the majority of subcritical asymptomatic carotid plaque on treatment with low–medium dosage statin presented a stable or increased echogenicity. Although vitamin K2 beyond standard therapy did not determine a significant change in plaque composition, for those who presented with GSM reduction it did enhance a GSM monthly decline.

Sex Differences in the Perception of Romantic Love-Mate Attraction

1978 ◽  
Vol 47 (3_suppl) ◽  
pp. 1089-1090 ◽  
Author(s):  
Robert J. Pellegrini
Keyword(s):  
Sex Differences ◽  
Romantic Love ◽  
Female Respondent ◽  
Future Research ◽  
Men And Women ◽  
Mate Attraction ◽  
Sexist Attitudes ◽  
Significant Difference ◽  
Males And Females ◽  
Male Supremacy

A sample of 450 male and 450 female single young adults were questioned as to whether they regarded romantic love-mate attraction as (a) easier for men than for women, (b) easier for women than for men, or (c) equally difficult for men and women. For both the males and females surveyed, the “equally difficult” alternative was endorsed the most frequently, the “easier for women” alternative the next most frequently, and the “easier for men” alternative the least frequently. The significant difference between the two distributions reflects a greater tendency among male than among female respondent to see mate attraction as easier for women. The results are thus contradictive of sexist attitudes of male supremacy in young people of both sexes, at least as far as the interpersonal marketplace is concerned. Directions for future research are outlined.

Carotid Plaque Inflammation Assessed by 18F-FDG PET/CT and Lp-PLA2 Is Higher in Symptomatic Patients

Angiology ◽  
2020 ◽  
pp. 000331972096541
Author(s):  
Alicia Bueno ◽  
Jose Ramon March ◽  
Pilar Garcia ◽  
Cristina Cañibano ◽  
Antonio Ferruelo ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Carotid Plaque ◽  
Carotid Plaques ◽  
Fdg Uptake ◽  
Standardized Uptake Values ◽  
Asymptomatic Patients ◽  
Pet Ct ◽  
Significant Difference ◽  
Plaque Inflammation ◽  
Artery Disease

Carotid plaque inflammation assessed by 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels are higher in symptomatic patients. The aim of this study was to assess correlations between 18F-FDG uptake on PET scan of carotid artery plaques, plasma levels of Lp-PLA2, and cerebrovascular symptoms. The study included 45 consecutive patients (22 symptomatic, 23 asymptomatic) with >70% carotid stenosis. Patients were examined by hybrid PET/CT, and maximum standardized uptake values (SUVmax) were recorded. Blood samples were obtained, and plasma was stored at −80 °C for subsequent Lp-PLA2 analysis. Symptomatic and asymptomatic patients showed no significant difference in classical cardiovascular risk factors. Asymptomatic carotid stenosis patients more frequently had a history of coronary artery disease ( P = .025) and peripheral artery disease ( P = .012). The symptomatic group had higher 18F-FDG uptake in carotid plaques ( P < .001), higher plasma Lp-PLA2 ( P < .01), and higher high-sensitive C-reactive protein ( P = .022). 2-Deoxy-2-[18F]fluoro-D-glucose uptake on PET/CT and plasma Lp-PLA2 show a statistically significant association with the symptomatic status of carotid plaques.

Achilles Tendon Thickness Is an Independent Predictor of Carotid Atherosclerosis and Is Associated With a Carotid Plaque Burden

Angiology ◽  
2020 ◽  
Vol 71 (8) ◽  
pp. 734-739
Author(s):  
Vadim Genkel ◽  
Alla Kuznetsova ◽  
Evgeny Lebedev ◽  
Anton Sinitskii ◽  
Lubov Pykhova ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Carotid Stenosis ◽  
Carotid Plaque ◽  
Carotid Atherosclerosis ◽  
Independent Predictor ◽  
Plaque Burden ◽  
Cross Sectional ◽  
Plaque Score ◽  
Tendon Thickness ◽  
Very High

The aim of the study was to research the relationship between carotid atherosclerosis markers and ultrasound parameters of Achilles tendons (AT). The study included 150 patients at high and very high cardiovascular risk (CVR). All patients underwent a carotid ultrasound scanning. We evaluated carotid plaque, carotid plaque score (cPS), carotid total plaque area (cTPA), and the percentage of stenosis. All patients underwent AT ultrasound with an assessment of thickness (Achilles tendon thickness [ATT]), width (Achilles tendon width), and cross-sectional area. An increase in the ATT ≥5.07 mm was associated with a 4.55-fold increase in the relative risk of carotid atherosclerosis (sensitivity 68.3% and specificity 62.5%). Direct correlations between the ATT and carotid stenosis ( r = 0.277; P = .004), cPS ( r = 0.225; P = .035), and cTPA ( r = 0.305; P = .004) were determined. An increase in the mean ATT by 1 mm was associated with an increase in cTPA by 8.09 mm2 (95% CI: 2.26-13.9; P = .007) and carotid stenosis by 4.11% (95% CI: 0.64-7.60; P = .021). Thus, in patients with high and very high CVR, an increase in ATT is an independent predictor of carotid atherosclerosis. The ATT directly correlates with the markers of carotid plaque burden.

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