颈动脉斑块抵消了年轻高血压患者心血管风险中的性别差异。

Carotid plaque offsets sex-related differences in cardiovascular risk of young hypertensive patients.

作者信息

Mancusi Costantino, Basile Christian, Gerdts Eva, Fucile Ilaria, Manzi Maria Virginia, Lembo Maria, Pacella Daniela, Giugliano Giuseppe, Canciello Grazia, Piccolo Raffaele, Spinelli Alessandra, Morisco Carmine, De Luca Nicola, Trimarco Bruno, de Simone Giovanni, Bossone Eduardo, Izzo Raffaele, Losi Maria Angela, Esposito Giovanni

机构信息

Hypertension Research Center and Department of Advanced Biomedical Science, Federico II University, Naples, Italy.

Hypertension Research Center and Department of Advanced Biomedical Science, Federico II University, Naples, Italy; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.

出版信息

Eur J Intern Med. 2024 Dec;130:137-143. doi: 10.1016/j.ejim.2024.09.007. Epub 2024 Sep 17.

DOI:10.1016/j.ejim.2024.09.007

PMID:39294033

Abstract

BACKGROUND

Women have a lower risk for cardiovascular (CV) disease compared to men. Whether this difference is influenced by the presence of hypertension-mediated organ damage is unknown.

OBJECTIVE

To assess whether the presence of carotid plaque (CP) impacts the sex difference in risk for CV events in treated hypertensive patients.

METHODS

From the Campania Salute Network Registry 2419 women and men <51 years of age with treated hypertension and free from prevalent CV disease were included. The presence of CP was identified by Doppler ultrasound (intima-media thickness≥1.5 mm). The primary outcome was a composite of fatal and non-fatal stroke or myocardial infarction, sudden death, TIA, myocardial revascularization, de novo angina, and atrial fibrillation.

RESULTS

Among patients without CP at baseline (n = 1807), women were older, with higher systolic blood pressure, serum cholesterol level and prevalence of LVH but lower serum triglycerides and eGFR, compared to men (all p < 0.001). Among patients with CP (n = 612), women were older, used higher number of antihypertensive drugs, had higher serum cholesterol level and prevalence of left ventricular hypertrophy (LVH), but had lower serum triglycerides and eGFR compared to men (all p < 0.001). During follow-up, women without CP had a lower risk for CV disease than men (hazard ratio, HR, 0.51, 95 % confidence intervals, CI, 0.27-0.99, p = 0.04) after accounting for cardiovascular risk factors, LVH, and antihypertensive treatment. In contrast, among patients with CP, women had similar risk for CV disease compared with men (HR 1.3, 95 % CI, 0.59-2.9, p = 0.48).

CONCLUSIONS

Our findings suggest that the presence of CP in young patients with treated hypertension offsets the CV disease protection in women.

TRIAL REGISTRATION

NCT02211365.

摘要

背景

与男性相比，女性患心血管（CV）疾病的风险较低。这种差异是否受高血压介导的器官损害影响尚不清楚。

目的

评估颈动脉斑块（CP）的存在是否会影响接受治疗的高血压患者发生CV事件风险的性别差异。

方法

纳入坎帕尼亚健康网络登记处2419名年龄小于51岁、接受过高血压治疗且无CV疾病史的男性和女性。通过多普勒超声（内膜中层厚度≥1.5mm）确定CP的存在。主要结局是致命性和非致命性中风或心肌梗死、猝死、短暂性脑缺血发作（TIA）、心肌血运重建、新发心绞痛和心房颤动的复合结局。

结果

在基线时无CP的患者（n = 1807）中，与男性相比，女性年龄更大，收缩压、血清胆固醇水平和左心室肥厚（LVH）患病率更高，但血清甘油三酯和估算肾小球滤过率（eGFR）更低（所有p < 0.001）。在有CP的患者（n = 612）中，与男性相比，女性年龄更大，使用的抗高血压药物数量更多，血清胆固醇水平和左心室肥厚（LVH）患病率更高，但血清甘油三酯和eGFR更低（所有p < 0.001）。在随访期间，在考虑心血管危险因素、LVH和抗高血压治疗后，无CP的女性患CV疾病的风险低于男性（风险比，HR，0.51，95%置信区间，CI，0.27 - 0.99，p = 0.04）。相比之下，在有CP的患者中，女性患CV疾病的风险与男性相似（HR 1.3，95% CI，0.59 - 2.9，p = 0.48）。