Men vs Women More Likely to Have Vulnerable Carotid Plaque, Increased Stroke Risk

Investigators conducted a study to determine any differences in carotid plaque composition and morphology in men vs women with stroke.

Among individuals with carotid stenosis, men are more likely than women to have carotid plaque at risk for rupture, characterized by intraplaque hemorrhage (IPH), lipid-rich necrotic core, and other vulnerable plaque components, according to a study published in Stroke.

For the current study, researchers included 224 individuals from the PARISK (Plaque At Risk) study ( Identifier: NCT01208025) with recent ischemic cerebrovascular symptoms and under 70% ipsilateral carotid stenosis. Multidetector-row CTA (MDCTA) and MRI were used to assess plaque characteristics, total plaque volume, thin-or-ruptured fibrous cap, ulcerations, and calcifications. After exclusions, 186 individuals (71% men) had both MRI and MDCTA of the carotid artery available. Multivariable logistic and linear regression was used to investigate sex differences across plaque characteristics.

Men and women exhibited significantly different total plaque volumes, with mean volumes of 1399±425 mm3 and 1011±242 mm3 among men and women, respectively (P<.001). After adjustment for total plaque volume, men were more likely than women to have both IPH (49% vs 16%; P<.001; odds ratio [OR], 2.8; 95% CI, 1.3-6.3) and lipid-rich necrotic core (73% vs 41%; P<.001; OR, 2.4; 95% CI, 1.2-4.7). Volumes of IPH, lipid-rich necrotic core, and calcifications did not differ by sex after correction for plaque volume. Men were also more likely to have calcifications with lipid-rich necrotic core and IPH (OR, 2.7; 95% CI, 1.2-7.0); calcifications with coexistent thin-or-ruptured fibrous cap/ulcerations, IPH, and lipid-rich necrotic core (OR, 2.4; 95% CI, 1.1-5.9); and calcifications with all plaque characteristics in coexistence (OR, 3.0; 95% CI, 1.2-8.6).

Limitations to this study include uneven distribution of men and women, a lack of data on sex hormones and menopause status, and a cross-sectional design.

The study researchers stated that “men are more likely to have a high-risk carotid plaque with IPH and [lipid-rich necrotic core] than women, regardless of the total plaque burden.” Furthermore, researchers indicated that men more often exhibit “plaque with multiple vulnerable plaque components which could comprise an even higher stroke risk.”


van Dam-Nolen DHK, van Egmond NCM, Dilba K, et al. Sex differences in plaque composition and morphology among symptomatic patients with mild-to-moderate carotid artery stenosis. Stroke. Published online January 5, 2022. doi:10.1161/STROKEAHA.121.036564