Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Republic of Korea.
J Cardiol. 2010 Sep;56(2):211-9. doi: 10.1016/j.jjcc.2010.05.009. Epub 2010 Jul 4.
The aim of this study was to evaluate the gender differences in plaque components in acute coronary syndrome (ACS) patients.
We used virtual histology-intravascular ultrasound to evaluate the plaque components in culprit lesions in 362 ACS patients (254 men, 108 women).
Women were more likely to be diabetic (34% vs 23%, p=0.030), had greater percentage necrotic core (%NC) volume (19.0±12.7% vs 16.8±11.9%, p=0.040), and had trends toward higher high-sensitivity C-reactive protein (hs-CRP) (0.85±1.28 mg/dl vs 0.53±0.48 mg/dl, p=0.063), and higher incidence of thin-cap fibroatheroma (TCFA) (62% vs 52%, p=0.078) compared with men. %NC volume was significantly greater in diabetic patients compared with nondiabetic patients (20.4±10.2% vs 16.0±8.9%, p<0.001) and was significantly greater in patients with elevated hs-CRP (≥0.2 mg/dl) compared with those with normal hs-CRP (<0.2 mg/dl) (18.8±8.9% vs 16.6±9.7%, p=0.021). However, there were no differences in plaque components between diabetic women and men, and between women and men with elevated hs-CRP levels. Diabetes [odds ratio (OR): 2.44, 95% confidence interval (CI): 1.35-3.82, p=0.003] and hs-CRP (OR: 1.54, 95% CI: 1.08-2.65, p=0.032), but not female gender, were the independent predictors of TCFA.
Although it seems likely that female ACS patients have more vulnerable plaque components compared with male ACS patients, these findings may result not from true gender differences in plaque components but higher prevalence of diabetes and hs-CRP elevation in women.
本研究旨在评估急性冠脉综合征（ACS）患者斑块成分的性别差异。
我们使用虚拟组织学血管内超声评估 362 例 ACS 患者（254 例男性，108 例女性）罪犯病变中的斑块成分。
与男性相比，女性更有可能患有糖尿病（34% vs 23%，p=0.030），具有更大的坏死核心百分比体积（19.0±12.7% vs 16.8±11.9%，p=0.040），且超敏 C 反应蛋白（hs-CRP）水平较高（0.85±1.28mg/dl vs 0.53±0.48mg/dl，p=0.063），薄帽纤维粥样斑块（TCFA）的发生率也较高（62% vs 52%，p=0.078）。与非糖尿病患者相比，糖尿病患者的坏死核心百分比体积显著更大（20.4±10.2% vs 16.0±8.9%，p<0.001），且与 hs-CRP 水平升高（≥0.2mg/dl）的患者相比，hs-CRP 水平正常（<0.2mg/dl）的患者的坏死核心百分比体积也更大（18.8±8.9% vs 16.6±9.7%，p=0.021）。然而，糖尿病女性与男性之间、hs-CRP 水平升高的女性与男性之间的斑块成分并无差异。糖尿病（比值比：2.44，95%置信区间：1.35-3.82，p=0.003）和 hs-CRP（比值比：1.54，95%置信区间：1.08-2.65，p=0.032），而非女性性别，是 TCFA 的独立预测因子。
尽管女性 ACS 患者的易损斑块成分似乎比男性 ACS 患者更有可能，但这些发现可能不是由于斑块成分中真正的性别差异，而是女性中糖尿病和 hs-CRP 升高的患病率较高所致。
