Comparison Of Carotid Atherosclerosis Plaque Characteristics Between Elderly Men And Women Using Magnetic Resonance Vessel Wall Imaging

Purpose:Our study consisted of three sections and aimed to investigate the differences of carotid atherosclerotic characteristics between elderly men and women using magnetic resonance(MR)vessel wall imaging.The three sections were the differences of carotid wall between healthy elderly men and women,the differences of carotid atherosclerosis between asymptomatic atherosclerotic elderly men and women,and the differences of carotid atherosclerosis between symptomatic atherosclerotic elderly men and women.Methods:I.A total of 100 healthy elderly participants over 60 years old with neither recent cerebral ischemic symptoms in six months nor carotid plaque verified by ultrasound were included in our study,including 50 men and 50 women.This study compared the lumen area(LA),wall area(WA),total vessel area(TVA),normalized wall index(NWI),and wall thickness(WT)of carotid artery between men and women.II.Elderly participants over 60years old without recent cerebral ischemic symptoms in six months but with atherosclerotic plaque in at least one side of the carotid arteries detected by ultrasound were recruited in this study.A total of 87 elderly people(130 arteries with atherosclerotic plaque)underwent MR vessel wall imaging,including 47 men(76 vessels)and 40 women(54 vessels).This study compared the morphology features including LA,WA,TVA,NWI,WT and luminal stenosis,and composition features including the presence of calcification,lipid-rich necrotic core(LRNC),intraplaque hemorrhage(IPH),fibrous cap rupture(FCR),and high-risk plaque(HRP)between elderly men and women.HRP was defined as a plaque with at least one feature of large LRNC(LRNC area is larger than 40%wall area),IPH and FCR.III.A total of327 elderly patients over 60 years old with ischemic stroke and(or)transient ischemic attack(TIA)within two weeks,and atherosclerotic plaques in both carotid arteries which were detected by ultrasound were recruited in more than ten medical centers from northeast,north,east,and south China,including 231 men and 96 women.This study compared the morphology features such as LA,WA,TVA,NWI,WT and luminal stenosis,and composition features including the presence of calcification,LRNC,IPH,FCR,and HRP of the index carotid arteries and the features above in non-index carotid arteries between men and women using MR vessel wall imaging.Results:I.In the subset of healthy elderly participants without carotid plaque,men had significant greater LA(50.8±13.2 mm~2 vs 43.2±10.6 mm~2,p<0.001),WA(36.9±7.7 mm~2 vs34.0±11.2 mm~2,p=0.039),TVA(87.7±19.6 mm~2 vs 77.2±18.7 mm~2,p<0.001),and higher WT(1.4±0.3 mm vs 1.3±0.1 mm,p=0.001),and lower NWI(42.3±5.8%vs 44.2±4.8%,p=0.016)compared with women.After adjusting for clinical confounding factors,the significances of differences in LA(p=0.025),WA(p=0.014),TVA(p=0.015),and WT(p<0.001)between elderly men and women persisted.II.In asymptomatic atherosclerostic elderly patients,men had greater LA(50.0±15.8 mm~2 vs 41.0±12.6 mm~2,p=0.001),WA(45.5±9.1 mm~2 vs 37.2±8.0 mm~2,p<0.001),TVA(95.4±21.9 mm~2 vs 78.2±18.3 mm~2,p<0.001),and higher WT(1.5±0.2 mm vs 1.4±0.2 mm,p<0.001),and higher prevalence of calcification(50.0%vs 24.1%,p=0.003),LRNC(81.6%vs 59.3%,p=0.005),and HRP(30.3%vs 13.0%,p=0.021).After adjusting for clinical confounding factors,the differences in LA(p=0.004),WA(p<0.001),TVA(p<0.001),WT(p=0.004),the prevalence of calcification(p=0.037),LRNC(p=0.025),and HRP(p=0.046)persisted in multivariable Model 1.After adjusting for the clinical confounding factors above and NWI,the differences in the prevalence of calcification(p=0.039)and LRNC(p=0.022)between sexes were still significant in multivariable Model 2.III.In the subset of symptomatic atherosclerotic elderly patients,men had greater WA(35.8±13.2 mm~2 vs 27.5±7.9 mm~2,p<0.001),TVA(81.2±20.2mm~2 vs 70.5±19.8 mm~2,p<0.001),NWI(44.9±10.8%vs 40.2±7.1%,p=0.001),higher WT(1.3±0.4 mm vs 1.0±0.2 mm,p<0.001)and luminal stenosis(23.7±36.4%vs 10.6±23.4%,p=0.005),and were more prevalent to have LRNC(75.8%vs 47.9%,p<0.001),IPH(23.8%vs 5.2%,p<0.001),FCR(12.1%vs 4.2%,p=0.027),and HRP(33.8%vs 11.5%,p<0.001)in the comparison of the index carotid arteries between men and women.Then the clinical confounding factors were adjusted.The significances of the differences in WA(p=0.008),TVA(p=0.008),WT(p=0.024),and the prevalence of LRNC(p=0.032)and IPH(p=0.024)between sexes stayed still in multivariable Model 1.After adjusting for the confounding factors in multivariable Model 1 and NWI(multivariable Model 2),there was no differences of carotid morphological characteristics between men and women.In the comparison of the non-index carotid arteries,elderly men had greater LA(48.4±17.1 mm~2 vs 43.6±13.6 mm~2,p=0.014),WA(34.3±11.7 mm~2 vs 26.4±6.6 mm~2,p<0.001),TVA(82.7±22.3 mm~2 vs70.0±17.7 mm~2,p<0.001),NWI(42.7±9.1%vs 39.1±6.6%,p=0.001),higher WT(1.2±0.4mm vs 1.0±0.2 mm,p<0.001)and luminal stenosis(17.7±30.6%vs 6.5±17.2%,p<0.001),more prevalence to suffer from calcification(48.5%vs 34.4%,p=0.019),LRNC(71.9%vs38.5%,p<0.001),IPH(19.0%vs 2.1%,p<0.001),FCR(7.4%vs 1.0%,p=0.023),and HRP(23.8%vs 5.2%,p<0.001).After adjusting for the clinical confounding factors,the significances of differences in WA(p<0.001),TVA(p=0.002),NWI(p=0.012),WT(p<0.001),luminal stenosis(p=0.044),the prevalence of LRNC(p<0.001),IPH(p=0.002),FCR(p=0.030),and HRP(p=0.001)existed in multivariable Model 1.The prevalence of LRNC(p<0.001),IPH(p=0.027),and HRP(p=0.020)between men and women were significantly different after adjusting for the clinical confounding factors in multivariable Model 1 and NWI(multivariable Model 2).Conclusion:In elderly participants without carotid plaque,compared with women,men had larger size of carotid artery and thicker wall thickness.In asymptomatic elderly patients with plaque in at least one side of carotid artery,men had larger size of carotid artery,thicker wall thickness,and more prevalent of calcification and LRNC than women.In elderly patients with stroke and(or)TIA and atherosclerotic plaques in both carotid arteries,compared with women,men had larger size of carotid artery and thicker wall thickness,in addition,men had larger NWI,severer luminal stenosis,more vulnerable atherosclerotic features and higher prevalence of vulnerable plaques in the non-index carotid arteries.