Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, the Netherlands.
Department of Vascular Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
Atherosclerosis. 2020 Oct;310:1-10. doi: 10.1016/j.atherosclerosis.2020.07.016. Epub 2020 Jul 29.
The sex- and age-related differences in the composition of iliofemoral atherosclerotic plaques are largely unknown. Therefore, the aim of the current study is to gain insight into plaque composition across strata of age and sex in a large cohort of vascular surgery patients.
Peripheral atherosclerotic plaques of patients who underwent iliofemoral endarterectomy (n = 790) were harvested between 2002 and 2014. The plaques were semi-quantitatively analyzed for the presence of lipid cores, calcifications, plaque hemorrhages (PH), collagen, macrophage and smooth muscle cell (SMC) content, and quantitatively for microvessel density. Patients were stratified by age tertiles and sex.
Ageing was independently associated with rupture-prone iliofemoral plaque characteristics, such as higher prevalence of plaque calcifications (OR 1.52 (95%CI:1.03-2.24) p = 0.035) and PH (OR 1.46 (95%CI:1.01-2.09) p = 0.042), and lower prevalence of collagen (OR 0.52 (95%CI:0.31-0.86) p = 0.012) and SMCs (OR 0.59 (95%CI:0.39-0.90) p = 0.015). Sex-stratified data showed that men had a higher prevalence of lipid cores (OR 1.62 (95%CI:1.06-2.45) p = 0.025) and PH (OR 1.62 (95%CI:1.16-2.54) p = 0.004) compared to women. These sex-differences attenuated with increasing age, with women showing an age-related increase in calcifications (p = 0.002), PH (p = 0.015) and decrease in macrophages (p = 0.005). In contrast, men only showed a decrease in collagen (p = 0.043).
Atherosclerotic iliofemoral plaques derived from men display more rupture-prone characteristics compared to women. Yet, this difference is attenuated with an increase in age, with older women having more rupture-prone characteristics compared to younger women.
目前对于男女在腹主动脉和股动脉粥样硬化斑块组成上的差异知之甚少。因此，本研究旨在深入了解在血管外科患者的大样本队列中，年龄和性别分层的斑块组成。
在 2002 年至 2014 年间，对接受腹主动脉和股动脉内膜切除术的患者的外周动脉粥样硬化斑块进行了采集。采用半定量分析方法对斑块中脂质核心、钙化、斑块出血（PH）、胶原、巨噬细胞和平滑肌细胞（SMC）含量进行了分析，并对微血管密度进行了定量分析。根据年龄三分位和性别对患者进行分层。
年龄的增长与易破裂的腹主动脉和股动脉粥样硬化斑块特征独立相关，如更高的斑块钙化（OR 1.52（95%CI：1.03-2.24），p=0.035）和 PH（OR 1.46（95%CI：1.01-2.09），p=0.042）的发生率，以及更低的胶原（OR 0.52（95%CI：0.31-0.86），p=0.012）和 SMC（OR 0.59（95%CI：0.39-0.90），p=0.015）的发生率。性别分层数据显示，与女性相比，男性的脂质核心（OR 1.62（95%CI：1.06-2.45），p=0.025）和 PH（OR 1.62（95%CI：1.16-2.54），p=0.004）的发生率更高。这些性别差异随着年龄的增长而减弱，女性的钙化（p=0.002）、PH（p=0.015）和巨噬细胞减少（p=0.005）与年龄相关。相反，男性仅表现出胶原减少（p=0.043）。
与女性相比，来源于男性的腹主动脉和股动脉粥样硬化斑块显示出更多易破裂的特征。然而，这种差异随着年龄的增长而减弱，与年轻女性相比，老年女性具有更多易破裂的特征。
