AUTHOR=Li Jie , Gao Lijie , Zhang Ping , Liu Yingying , Zhou Ju , Yi Xingyang , Wang Chun 

TITLE=Vulnerable Plaque Is More Prevalent in Male Individuals at High Risk of Stroke: A Propensity Score-Matched Study

JOURNAL=Frontiers in Physiology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2021.642192

DOI=10.3389/fphys.2021.642192

ISSN=1664-042X

ABSTRACT=Objectives: To assess the gender differences in the prevalence of carotid vulnerable plaque in individuals at high risk of stroke in a multicenter, cross-sectional survey.
Methods: In the year 2015, 18595 residents aged ≥ 40 participated in the face-to-face survey in eight communities in Sichuan province in southwestern China. A total of 2644 subjects at high risk of stroke were enrolled. Gender differences in the prevalence of carotid plaque and vulnerable plaque were compared before and after propensity score matching (PSM). Multivariate logistic regression was performed to identify the association between gender and carotid plaque. Stratified analyses and interaction test were conducted to identify variables that modify the association between gender and carotid plaque.
Results: Among 2644 high-risk individuals enrolled, there were 1202 (45.5%) men and 1442 (54.5%) women. Carotid plaques were found in 904 (34.2%) subjects, and 425 (16.1%) had vulnerable plaque. Before PSM, carotid plaque was more prevalent in men than in women (36.7% vs. 32.1%, p=0.01), as well as vulnerable plaque (20.0% vs. 12.8%, p<0.01). Men tend to have a higher prevalence of vulnerable plaque in multivariable analysis (adjusted OR 1.70, 95 % CI 1.10 to 2.62, p=0.02). Stratified analyses and interaction test demonstrated that the association between male sex and vulnerable carotid plaque did not change by age, family history of stroke, histories of chronic disease, smoking status, drinking status, physical activity and BMI (all p for interaction > 0.05). After PSM, vulnerable plaque was still more prevalent in men than in women (17.03% vs. 12.07%, p=0.032). 
Conclusion: Male individuals had a higher risk of vulnerable carotid plaque independent of classical vascular risk factors. Whether there is a gender-specific association between variations in genes involved in inflammation, endothelial function, and lipid metabolism and plaque vulnerability need to be further studied.