http://stroke.ahajournals.org/content/44/12/3318.abstract?etoc
- Joyce E.P. Vrijenhoek, MD;
- Hester M. Den Ruijter, PhD;
- Gert Jan De Borst, MD, PhD;
- Dominique P.V. de Kleijn, PhD;
- Jean-Paul P.M. De Vries, MD, PhD;
- Michiel L. Bots, MD, PhD;
- Sander M. Van de Weg, BSc;
- Aryan Vink, MD, PhD;
- Frans L. Moll, MD, PhD;
- Gerard Pasterkamp, MD, PhD
+ Author Affiliations
- Correspondence to Joyce E.P. Vrijenhoek, MD, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands. E-mail j.e.p.vrijenhoek@umcutrecht.nl
Abstract
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.
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