Nicholls Stephen J, Wolski Kathy, Sipahi Ilke, Schoenhagen Paul, Crowe Timothy, Kapadia Samir R, Hazen Stanley L, Tuzcu E Murat, Nissen Steven E
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Am Coll Cardiol. 2007 Apr 10;49(14):1546-51. doi: 10.1016/j.jacc.2006.12.039. Epub 2007 Mar 26.
The purpose of this study was to determine the relationship between gender and the extent of coronary atherosclerosis assessed by intravascular ultrasound (IVUS) and its rate of progression in subjects treated with established medical therapies.
It is uncertain whether the pathophysiology of coronary artery disease (CAD) differs between genders.
A systematic analysis was performed of 978 subjects who participated in serial studies of atheroma progression. Genders were compared with regard to the extent of coronary atheroma at baseline and subsequent change in response to use of established medical therapies.
Women were more likely to have a history of hypertension and higher levels of body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, C-reactive protein, and systolic and diastolic blood pressure. Despite this, women had less plaque in terms of percent atheroma volume (PAV) (33.9 +/- 10.2% vs. 37.8 +/- 10.3%, p < 0.001) and total atheroma volume (TAV) (148.7 +/- 66.6 mm3 vs. 194.7 +/- 84.3 mm3, p < 0.001). With medical therapy, the rate of change of PAV (0.7 +/- 0.6% vs. 0.7 +/- 0.5%, p = 0.92) and TAV (-2.3 +/- 3.2 mm3 vs. -1.9 +/- 2.9 mm3, p = 0.84) did not differ between genders. In the setting of intensive risk factor modification, there was no significant difference between genders with regard to the rates of plaque progression or regression.
Despite the presence of more risk factors, the extent of atheroma in women with angiographic CAD is less than in men in subjects participating in clinical trials that employed serial assessments with IVUS. The finding that the rate of plaque progression or regression does not differ between genders in the setting of intensive risk factor modification supports the use of established medical therapies in women with CAD.
本研究旨在确定在接受既定药物治疗的受试者中，性别与通过血管内超声（IVUS）评估的冠状动脉粥样硬化程度及其进展速率之间的关系。
冠状动脉疾病（CAD）的病理生理学在不同性别之间是否存在差异尚不确定。
对978名参与动脉粥样硬化进展系列研究的受试者进行了系统分析。比较了不同性别在基线时冠状动脉粥样硬化的程度以及在使用既定药物治疗后的后续变化。
女性更有可能有高血压病史，且体重指数、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、C反应蛋白以及收缩压和舒张压水平更高。尽管如此，女性的粥样硬化体积百分比（PAV）（33.9±10.2%对37.8±10.3%，p<0.001）和总粥样硬化体积（TAV）（148.7±66.6mm³对194.7±84.3mm³，p<0.001）方面的斑块较少。在药物治疗下，PAV的变化率（0.7±0.6%对0.7±0.5%，p = 0.92）和TAV的变化率（-2.3±3.2mm³对-1.9±2.9mm³，p = 0.84）在不同性别之间没有差异。在强化风险因素控制的情况下，不同性别在斑块进展或消退速率方面没有显著差异。
尽管存在更多风险因素，但在采用IVUS进行系列评估的临床试验受试者中，血管造影显示患有CAD的女性的粥样硬化程度低于男性。在强化风险因素控制的情况下，不同性别在斑块进展或消退速率方面没有差异这一发现支持在患有CAD的女性中使用既定的药物治疗。
