Sex Differences in Nonculprit Coronary Plaque Microstructures on Frequency-Domain Optical Coherence Tomography in Acute Coronary Syndromes and Stable Coronary Artery Disease
Sex Differences in Nonculprit Coronary Plaque Microstructures on Frequency-Domain Optical Coherence Tomography in Acute Coronary Syndromes and Stable Coronary Artery Disease
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DOI：
10.1161/circimaging.116.004506
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发表时间：
2016-08-01
影响因子：
7.5
通讯作者：
Nicholls, Stephen J.
中科院分区：
文献类型：
--
作者：
Kataoka, Yu;Puri, Rishi;Nicholls, Stephen J.
背景-大量的报道表明动脉粥样硬化的性别差异。频域光学相干断层扫描已经能够可视化与疾病不稳定性相关的斑块微观结构。两性之间斑块微结构的患病率尚未得到表征。我们调查了冠状动脉疾病患者斑块特征的性别差异。方法和结果：在稳定性冠状动脉疾病（n=320）或急性冠状动脉综合征（n=115）的男性和女性之间比较频域光学相干断层扫描成像的非罪犯斑块。在妇女中观察到心血管危险因素的发生率更高。稳定型冠心病女性患者的非罪犯斑块更容易出现斑块侵蚀（8.6% vs 0.3%; P=0.03）和较小的脂质弧（163.1 +/- 71.4度vs 211.2 +/- 71.2度; P=0.03），并且不太可能存在胆固醇晶体（17.2% vs 27.5%; P=0.01）和钙化（15.4%对34.4%; P=0.008），而纤维帽厚度（105.2 +/- 62.1 vs 96.1 +/- 40.4 μ m; P=0.57），薄帽纤维粥样硬化的患病率（26.5%对25.2%; P=0.85）和微通道（19.2%对20.5%; P=0.95）相当。在患有急性冠脉综合征的女性中，（171.6 +/- 53.2度与235.8 +/- 86.4度; P=0.03），斑块侵蚀的频率较高胆固醇结晶（28.6%对38.2%; P = 0.03）和钙化（10.0%对23.7%; P=0.01）的患病率较低。这些差异在调整临床人口统计学后仍然存在。虽然薄帽纤维粥样硬化在男性聚集在近端动脉段，薄帽纤维粥样硬化均匀分布在women. Conclusions，尽管更多的共病危险因素的妇女，他们的非罪犯斑块表现出更多的斑块侵蚀，和更少的胆固醇和钙含量。这种独特的表型表明动脉粥样硬化的病理生理学存在性别相关的差异。
Background-Numerous reports suggest sex-related differences in atherosclerosis. Frequency-domain optical coherence tomography has enabled visualization of plaque microstructures associated with disease instability. The prevalence of plaque microstructures between sexes has not been characterized. We investigated sex differences in plaque features in patients with coronary artery disease.Methods and Results-Nonculprit plaques on frequency-domain optical coherence tomography imaging were compared between men and women with either stable coronary artery disease (n=320) or acute coronary syndromes (n=115). A greater prevalence of cardiovascular risk factors was observed in women. Nonculprit plaques in women with stable coronary artery disease were more likely to exhibit plaque erosion (8.6% versus 0.3%; P=0.03) and a smaller lipid arc (163.1 +/- 71.4 degrees versus 211.2 +/- 71.2 degrees; P=0.03), and less likely to harbor cholesterol crystals (17.2% versus 27.5%; P=0.01) and calcification (15.4% versus 34.4%; P=0.008), whereas fibrous cap thickness (105.2 +/- 62.1 versus 96.1 +/- 40.4 mu m; P=0.57), the prevalence of thin-cap fibroatheroma (26.5% versus 25.2%; P=0.85), and microchannels (19.2% versus 20.5%; P=0.95) were comparable. In women with acute coronary syndrome, a smaller lipid arc (171.6 +/- 53.2 degrees versus 235.8 +/- 86.4 degrees; P=0.03), a higher frequency of plaque erosion (11.4% versus 0.6%; P=0.04), and a lower prevalence of cholesterol crystal (28.6% versus 38.2%; P=0.03) and calcification (10.0% versus 23.7%; P=0.01) were observed. These differences persisted after adjusting clinical demographics. Although thin-cap fibroatheromas in men clustered within proximal arterial segments, thin-cap fibroatheromas were evenly distributed in women.Conclusions-Despite more comorbid risk factors in women, their nonculprit plaques exhibited more plaque erosion, and less cholesterol and calcium content. This distinct phenotype suggests sex-related differences in the pathophysiology of atherosclerosis.