Has gender a significant impact on carotid plaque instability and inflammation? Evidence from a 457-patient clinicopathologic study

Purpose: Severe carotid stenosis is a frequent cause of stroke in both men and women. Whereas several sex-related comparisons are available on coronary plaque features, there are few data appraising gender-specific features of carotid plaques. We thus aimed to systematically compare the pathology of carotid plaques in males versus females. Methods: Carotid plaque specimens were collected from patients undergoing surgical thromboendoarterectomy for asymptomatic or symptomatic carotid stenosis. Standard pathologic analyses were performed, as well as sophisticated measurements for plaque hemorrhage, inflammation and foam cells. Results: A total of 457 patients were included (132 women, 325 men). Baseline analyses showed a greater prevalence of hypercholesterolemia and hypertension in women, and higher prevalence of current smoking, despite a raised Framingham Heart score in men (all p<0.05). Women had a lower prevalence of thrombotic plaques, and smaller percentage area of necrotic core and hemorrhage extension (all p<0.05). Plaque inflammation analysis showed a lower concentration of inflammatory and foam cells in the plaque cap of females (both p