Gender characteristics of atheroscleroticlesions of carotid arteries

Authors: Glushkov N.I., Ivanov M.A., Artemova A.S., Gorovaya A.D., Uryupina A.A.

Company: North-Western State Medical University named after I.I. Mechnikov of Ministry of Health of the Russian Federation, Piskarevskiy prospect, 47, Saint-Petersburg, 195076, Russian Federation

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Type:  Original articles


For citation: Glushkov N.I., Ivanov M.A., Artemova A.S., Gorovaya A.D., Uryupina A.A. Gender characteristics of atherosclerotic lesions of carotid arteries. Creative Cardiology. 2019; 13 (1): 8–16 (in Russ.). DOI: 10.24022/ 1997-3187-2019-13-1-8-16

Received / Accepted:  04.02.2019/07.02.2019

Keywords: carotid endarterectomy gender differences

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Objective. To study the gender characteristics of atherosclerotic lesions of the carotid arteries, as well as the results of carotid endarterectomy.

Material and methods. The course of atherosclerotic lesions of the carotid arteries was studied in 88 patients. The patients were divided into 2 groups by gender: 21 female patients were included in the main group, 67 male patients made up the control group. Analyzed metabolic abnormalities (glucose level, lipid spectrum), blood pressure level before surgery, especially atherosclerotic lesions of the brachiocephalic arteries. All patients underwent carotid endarterectomy. The course of the postoperative period, the presence of complications (development of transient ischemic attacks, ischemic stroke, atrial fibrillation) in the early postoperative period and long-term periods up to 5 years were analyzed.

Results. The atherosclerotic process in women was characterized by more pronounced metabolic changes and perioperative hemodynamic instability: diabetes mellitus was more common in females (42.9% vs. 14.9, p<0.05), the level of total cholesterol was higher in women (6.4±0.5 mmol/l vs. 6.1±0.77; p<0.05). The intraoperative systolic pressure fluctuations were 54.4±9.8 mm Hg in women and 42.6±19.7 mmHg in men (p<0.05). The early postoperative period was characterized by hemodynamic instability on the first day in females: the maximum systolic blood pressure in women was 185.3±21.1 and 159.1±23.5 mm Hg in men (p=0.004); more pronounced fluctuations in systolic blood pressure were characteristic of women (82.5±33.9 mm Hg vs. 44.9±16.3, p=0.0001). Complications were more common in females at early stages after surgery: atrial fibrillation was recorded in 2 (9.5%) patients, in males this complication was not recorded (p<0.05), transient ischemic attacks in the early stages after surgery, 1 (1.5%) man and 1 (4.8%) woman (p=0.38) were recorded; acute cerebral circulation was detected early in 1 female patient (p=0.2).

Conclusion. Patients with atherosclerotic lesions of the carotid arteries are characterized by more pronounced metabolic disorders (presence and severity of carbohydrate metabolism disorders, changes in the blood lipid spectrum) compared with men, which could affect the incidence of postoperative complications in females.


  1. Flaherty M.L., Kissela B., Khoury J.C., Alwell K., Moomaw C.J., Woo D. et al. Carotid artery stenosis as a cause of stroke. Neuroepidemiology. 2013; 40 (1): 36–41. DOI: 10.1159/000341410
  2. Haast R.A.M., Gustafson D.R., Kiliaan A.J. Sex differences in stroke. J. Cereb. Blood Flow Metab. 2012; 32 (12): 2100-7. DOI: 10.1038/jcbfm.2012.141
  3. Hellings W.E., Pasterkamp G., Verhoeven B.A.N., De Kleijn D.P.V., De Vries J.-P.P.M., Seldenrijk K.A. et al. Gender-associated differences in plaque phenotype of patients undergoing carotid endarterectomy. J. Vasc. Surg. 2007; 45 (2): 289–96. DOI: 10.1016/j.jvs.2006.09.051
  4. Appelros P., Stegmayr B., Terent A. A review on sex differences in stroke treatment and outcome. Acta Neurol. Scand. 2010; 121: 359–69. DOI: 10.1111/j.1600-0404.2009.01258.x
  5. Olsen T.S., Andersen Z.J., Andersen K.K. Age trajectories of stroke case fatality: leveling off at the highest ages. Epidemiology. 2011; 22: 432–6. DOI: 10.1161/STROKEAHA.111.619049
  6. Han S.H., Bae J.H., Holmes D.R., Lennon R.J., Eeckhout E., Barsness G.W. et al. Sex differences in atheroma burden and endothelial function in patients with early coronary atherosclerosis. Eur. Heart J. 2008; 29: 1359–69. DOI: 10.1093/eurheartj/ehn142
  7. Van Kempen T.A., Milner T.A., Waters E.M. Accelerated ovarian failure: a novel, chemically induced animal model of menopause. Brain Res. 2011; 1379: 176–87. DOI: 10.1016/j.brainres.2010.12.064
  8. Tian Y., Stamova B., Jickling G.C., Liu D., Ander B.P., Bushnell C. et al. Effects of genderon gene expression in the blood of ischemic stroke patients. J. Cereb. Blood Flow. Metab. 2012; 32: 780–91. DOI: 10.1038/jcbfm.2011.179
  9. Meschia J.F., Klaas J.P., Brown R.D., Jr., Brott Th.G. Evaluation and management of atherosclerotic carotid stenosis. Mayo Clin. Proc. 2017; 92 (7): 1144–57. DOI: 10.1016/j.mayocp.2017.02.020
  10. Reeves M.J., Bushnell C.D., Howard G., Gargano J.W., Duncan P.W., Lynch G. et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol. 2008; 7: 915–26. DOI: 10.1016/S1474-4422(08)70193-5
  11. Matz O., Nikoubashman O., Rajkumar P., Keuler A., Wiesmann M., Schulz J.B. et al. Grading of proximal internal carotid artery (ICA) stenosis by Doppler/ duplex ultrasound (DUS) and computed tomographic angiography (CTA): correlation and interrater reliability in real-life practice. Acta Neurol. Belg. 2016; 117 (1): 183–8. DOI: 10.1007/s13760-016-0676-4
  12. Powers W.J., Derdeyn C.P., Biller J., Coffey C.S., Hoh B.L., Jauch E.C. et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: a guideline for healthcare professionals from the American Heart Association. American Stroke Association. Stroke. 2015; 46 (10): 3020–35. DOI: 10.1161/STR.0000000000000074
  13. Gupta A., Baradaran H., Schweitzer A.D., Kamel H., Pandya A., Delgado D. et al. Carotid plaque MRI and stroke risk: a systematic review and meta-analysis. Stroke. 2013; 44 (11): 3071–7. DOI: 10.1161/STROKEAHA.113.002551
  14. Akbari C.M., Pulling M.C., Pomposelli F.B., Gibbons G.W., Campbell D.R., LoGerfo F.W. Gender and carotid endarterectomy: does it matter? J. Vasc. Surg. 2000; 31: 1103–9. DOI: 10.1067/mva.2000.106490
  15. Hansen F., Mangell P., Sonesson B., Länne T. Diameter and compliance in the human common carotid artery-variations with age and sex. Ultrasound Med. Biol. 1995; 21: 1–9. DOI: 10.1155/2007/3257
  16. Schulz U.G., Rothwell P.M. Sex differences in carotid bifurcation anatomy and the distribution of atherosclerotic plaque. Stroke. 2001; 32: 1525–31. DOI: 10.1177/1747493018784448
  17. Iemolo F., Martiniuk A., Steinman D.A., Spence J.D. Sex differences in carotid plaque and stenosis. Stroke. 2004; 35: 477–81. DOI: 10.1161/01.STR.0000110981.96204.64
  18. Naghavi M., Libby P., Falk E., Casscells S.W., Litovsky S., Rumberger J. et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation. 2003; 108: 1664–72. DOI: 10.1161/01.cir.0000087480.94275.97
  19. Naghavi M., Libby P., Falk E., Casscells S.W., Litovsky S., Rumberger J. et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part II. Circulation. 2003; 108: 1772–8. DOI: 10.1161/JAHA. 117.005543
  20. Stary H.C., Chandler A.B., Dinsmore R.E., Fuster V., Glagov S., Insull W. et al. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. Arterioscler. Thromb. Vasc. Biol. 1995; 15: 1512–31. DOI: 10.1161/01.atv.15.9.1512
  21. Glushkov N.I., Ivanov M.A., Kebriakov A.V., Kopliarova N.S., Strizhonok M.A., Bondarenko P.B. Circumstances of hemodynamic instability risk in the perioperative process in patients with advanced atherosclerosis. Preventive and Clinical Medicine. 2016; 4 (61): 59–64 (in Russ.).
  22. Chernyavsky A.M., Kovaleva T.V., Averko N.N. et al. Cardiological aspects of surgical treatment of combined atherosclerotic lesions of coronary and carotid arteries in asymptomatic atherosclerosis of carotid arteries: Preprint. Novosibirsk; 2005: 1–15 (in Russ.).
  23. Chassin M.R. Appropriate use of carotid endarterectomy. N. Engl. J. Med. 1998; 339: 1468–71. DOI: 10.1161/01.STR.0000072514.79745.7D
  24. Kernan W.N., Ovbiagele B., Black H.R., Bravata D.M., Chimowitz M.I., Ezekowitz M.D. et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014; 45 (7): 2160–236. DOI: 10.1161/STR.0000000000000024
  25. Markus H.S., King A., Shipley M., Topakian R., Cullinane M., Reihill S. et al. Asymptomatic embolisation for prediction of stroke in the Asymp-tomatic Carotid Emboli Study (ACES): a prospective observational study. Lancet Neurol. 2010; 9 (7): 663–71. DOI: 10.1161/STROKEAHA.111.626770
  26. LeFevre M.L. Screening for asymptomatic carotid artery stenosis: U.S. Preventive Services Task Force recommendation statement. Ann. Intern. Med. 2014; 161 (5): 356–62. DOI: 10.7326/M14-1333
  27. Brott T.G., Halperin J.L., Abbara S., Bacharach J.M., Barr J.D., Bush R.L. et al. 2011 ASA/ACCF/ AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/ SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. Circulation. 2011; 124 (4): 54–130. DOI: 10.1161/CIR.0b013e31820d8d78
  28. Thompson R.C., Allam A.H., Lombardi G.P., Wann L.S., Sutherland M.L., Sutherland J.D. et al. Atherosclerosis across 4000 years of human history: the Horus study of four ancient populations. Lancet. 2013; 381 (9873): 1211–22. DOI: 10.1016/S0140-6736
  29. Taneja S., Chauhan S., Kapoor P.M., Jagia P., Bisoi A.K. Prevalence of carotid artery stenosis in neurologically asymptomatic patients undergoing coronary artery bypass grafting for coronary artery disease: Role of anesthesiologist in preoperative assessment and intraoperative management. Ann. Card. Anaesth. 2016; 19 (1): 76–83. DOI: 10.4103/0971-9784.173024

About Authors

  • Nikolay I. Glushkov, Dr Med. Sc., Professor, Chief of Chair,;
  • Mikhail A. Ivanov, Dr Med. Sc., Professor,;
  • Anastasiya S. Artemova, Resident Physician,;
  • Anastasiya D. Gorovaya, Student,;
  • Anastasiya A. Uryupina, Student,

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery