性别与动脉粥样硬化斑块出血的存在相关，并改变了斑块出血与心血管结局之间的关系。
Sex is associated with the presence of atherosclerotic plaque hemorrhage and modifies the relation between plaque hemorrhage and cardiovascular outcome.
机构信息
From the Experimental Cardiology Laboratory (J.E.P.V., H.M.D.R., D.P.V.d.K., S.M.V.d.W., G.P.), Julius Center of Health Sciences and Primary Care (H.M.D.R., M.L.B.), and Departments of Vascular Surgery (J.E.P.V., G.J.D.B., F.L.M.) and Pathology (A.V.), University Medical Center, Utrecht, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands (J.E.P.V., D.P.V.d.K.); Department of Surgery and Cardiovascular Research Institute, National University (NU) & National University Hospital (NUH), Singapore (D.P.V.d.K.); and Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands (J.-P.P.M.D.V.).
出版信息
Stroke. 2013 Dec;44(12):3318-23. doi: 10.1161/STROKEAHA.113.002633. Epub 2013 Oct 15.
BACKGROUND AND PURPOSE
Plaque hemorrhage (PH) may lead to accelerated progression of atherosclerotic disease. The presence of local PH in the carotid plaque predicts future cardiovascular events in any vascular territory. We investigated the prevalence of local PH and the predictive value of PH for the occurrence of cardiovascular events in men and women separately.
METHODS
Atherosclerotic plaques from 1422 patients (969 men, 453 women) who underwent carotid endarterectomy were analyzed histologically for the presence of PH. Patients were monitored for 3 years for cardiovascular events (nonfatal stroke, nonfatal myocardial infarction, vascular death, and vascular intervention).
RESULTS
Plaques from men showed a significantly higher prevalence of PH compared with women (67% versus 54%; P<0.001). In 1353 patients with available follow-up data, with a median duration of 2.9 years, 270 events had occurred in men (29%) and 94 in women (22%). Stratified by presence of PH, the event rate was 32% in men with PH versus 23% in men without PH, and 23% in women with PH versus 21% in women without PH. A multivariable Cox proportional hazards model found a significant interaction between sex and PH. PH was significantly associated with events in men (adjusted hazard ratio, 1.9; 95% CI, 1.2-2.8) but not in women (adjusted hazard ratio, 1.0; 95% CI, 0.6-1.7).
CONCLUSIONS
Atherosclerotic carotid plaques obtained from men reveal a higher prevalence of PH compared with women. Local PH is strongly related to secondary manifestations of cardiovascular disease in men but not in women.
背景与目的
斑块出血（PH）可能导致动脉粥样硬化疾病加速进展。颈动脉斑块中存在局部 PH 可预测任何血管区域的未来心血管事件。我们分别研究了男性和女性中局部 PH 的患病率以及 PH 对心血管事件发生的预测价值。
方法
对 1422 例接受颈动脉内膜切除术的患者（969 例男性，453 例女性）的动脉粥样硬化斑块进行组织学分析，以确定是否存在 PH。对患者进行了 3 年的心血管事件（非致死性中风、非致死性心肌梗死、血管性死亡和血管介入）监测。
结果
与女性相比，男性斑块 PH 的患病率明显更高（67%对 54%；P<0.001）。在 1353 例有随访数据的患者中，中位随访时间为 2.9 年，男性发生 270 例事件（29%），女性发生 94 例（22%）。按 PH 存在情况分层，PH 阳性男性的事件发生率为 32%，PH 阴性男性为 23%；PH 阳性女性为 23%，PH 阴性女性为 21%。多变量 Cox 比例风险模型发现性别和 PH 之间存在显著交互作用。PH 与男性的事件显著相关（调整后的危险比，1.9；95%可信区间，1.2-2.8），但与女性无关（调整后的危险比，1.0；95%可信区间，0.6-1.7）。
结论
与女性相比，男性颈动脉粥样硬化斑块中 PH 的患病率更高。局部 PH 与男性心血管疾病的继发性表现密切相关，但与女性无关。
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