Iemolo Francesco, Martiniuk Alexandra, Steinman David A, Spence J David
Department of Neurology, General Hospital R. Guzzardi Vittoria (Ragusa), A.S.L. 7 Sicilian Region, Italy.
Stroke. 2004 Feb;35(2):477-81. doi: 10.1161/01.STR.0000110981.96204.64. Epub 2004 Jan 22.
Women are relatively protected from cardiovascular events; they are 3 times as likely as men to survive to age 90 years. Although clinical trials show an excess of thrombotic events with estrogen/progestin hormone replacement therapy, much experimental and epidemiological evidence suggests that estrogen may have beneficial effects on endothelial function and atherosclerosis, raising the possibility of sex differences in arterial remodeling. We studied sex differences in carotid plaque and stenosis in relation to survival free of stroke, death, and myocardial infarction.
A total of 1686 patients from an atherosclerosis prevention clinic were followed annually for up to 5 years (mean, 2.5+/-1.3 years) with baseline and follow-up measurements; there were 45 strokes, 94 myocardial infarctions, and 41 deaths.
Carotid stenosis and plaque increased with age. Women had greater stenosis compared with men (P=0.001), whereas men had greater plaque area than did women at all ages (P<0.0001). Stroke, myocardial infarction, and death combined were predicted significantly by plaque area (P=0.004) but not by stenosis (P=0.042).
Women have more stenosis but less plaque than men, suggesting that differences in sex hormones may affect remodeling of atherosclerosis. Plaque area was a stronger predictor of outcomes than was stenosis.
女性相对较少发生心血管事件；她们活到90岁的可能性是男性的3倍。尽管临床试验表明雌激素/孕激素激素替代疗法会增加血栓形成事件的发生，但大量实验和流行病学证据表明，雌激素可能对内皮功能和动脉粥样硬化具有有益作用，这增加了动脉重塑存在性别差异的可能性。我们研究了颈动脉斑块和狭窄方面的性别差异与无中风、死亡及心肌梗死生存期的关系。
对来自一家动脉粥样硬化预防诊所的1686例患者进行了长达5年（平均2.5±1.3年）的年度随访，并进行了基线和随访测量；共发生45次中风、94次心肌梗死和41例死亡。
颈动脉狭窄和斑块随年龄增加。与男性相比，女性的狭窄程度更严重（P=0.001），而在所有年龄段，男性的斑块面积均大于女性（P<0.0001）。斑块面积可显著预测中风、心肌梗死和死亡的综合发生率（P=0.004），而狭窄程度则不能（P=0.042）。
女性的狭窄程度比男性更严重，但斑块比男性更少，这表明性激素差异可能影响动脉粥样硬化的重塑。斑块面积比狭窄程度更能有力地预测预后。
