Department of Cardiovascular Medicine, Kitasato University School of Medicine.
Circ J. 2020 Feb 25;84(3):463-470. doi: 10.1253/circj.CJ-19-0859. Epub 2020 Jan 25.
The pathophysiology and chronological course of atherosclerosis seems to be different between men and women due to biological differences, and age and gender differences in plaque composition of coronary lesions remain to be elucidated.
A total of 860 consecutive patients with a median age of 69 years (IQR, 60-78 years) who underwent optical coherence tomography (OCT) of culprit lesions was included. The composition of culprit plaque on OCT was compared between female (n=171) and male (n=689) subjects in younger (<70 years old) and elderly (≥70 years old) patients. In elderly patients, the prevalence of thin-cap fibroatheroma (TCFA) was significantly higher in women than in men (30.6 vs. 15.2%, P<0.001). In younger patients, the prevalence of large calcification was significantly higher in women than in men (60.0 vs. 32.8%, P<0.001). The prevalence of other vulnerable plaque characteristics (i.e., macrophages, microchannels, and spotty calcification), was similar between women and men. Elderly women had a significantly higher prevalence of TCFA (OR, 2.13; 95% CI: 1.33-3.44, P=0.002) than other patients.
Women had a higher prevalence of TCFA and of large calcification than men in patients ≥70 and <70 years old, respectively. This may facilitate the understanding of gender differences in the pathogenesis of coronary atherosclerosis, and the tailoring of therapy and of prevention according to age and gender.
由于生物学差异，男性和女性的动脉粥样硬化病理生理学和时间进程似乎不同，冠状动脉病变斑块成分的年龄和性别差异仍有待阐明。
共纳入 860 例连续患者，中位年龄为 69 岁（IQR，60-78 岁），接受罪犯病变光学相干断层扫描（OCT）检查。在年龄较小（<70 岁）和年龄较大（≥70 岁）的患者中，比较了女性（n=171）和男性（n=689）患者罪犯斑块的成分。在老年患者中，女性 TCFA 的患病率明显高于男性（30.6%比 15.2%，P<0.001）。在年轻患者中，女性大钙化的患病率明显高于男性（60.0%比 32.8%，P<0.001）。其他易损斑块特征（即巨噬细胞、微通道和点状钙化）的患病率在女性和男性之间相似。老年女性 TCFA 的患病率明显高于其他患者（OR，2.13；95%CI：1.33-3.44，P=0.002）。
无论年龄大小，女性 TCFA 和大钙化的患病率均高于男性。这可能有助于理解冠状动脉粥样硬化发病机制中的性别差异，并根据年龄和性别调整治疗和预防策略。
