颈动脉粥样硬化斑块可以预测女性心肌梗死风险

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Carotid Atherosclerosis Is a Stronger Predictor of Myocardial Infarction in Women Than in Men

A 6-Year Follow-Up Study of 6226 Persons: The Troms?Study

Stein Harald Johnsen, MD, PhD; Ellisiv B. Mathiesen, MD, PhD; Oddmund Joakimsen, MD, PhD; Eva Stensland, MD, PhD; Tom Wilsgaard, PhD; Maja-Lisa L鴆hen, MD, PhD; Inger Nj鴏stad, MD, PhD Egil Arnesen, MD

From the Departments of Neurology (S.H.J., E.B.M., O.J., E.S.) and Cardiology (M.-L.L.), University Hospital North-Norway, Troms? Norway; and the Institute of Clinical Medicine (E.B.M., O.J., E.S.) and the Institute of Community Medicine (T.W., M.-L.L., I.N., E.A.), University of Troms? Troms? Norway.

Background and Purpose— Ultrasound of carotid arteries provides measures of intima media thickness (IMT) and plaque, both widely used as surrogate measures of cardiovascular disease. Although IMT and plaques are highly intercorrelated, the relationship between carotid plaque and IMT and cardiovascular disease has been conflicting. In this prospective, population-based study, we measured carotid IMT, total plaque area, and plaque echogenicity as predictors for first-ever myocardial infarction (MI).

Methods— IMT, total plaque area, and plaque echogenicity were measured in 6226 men and women aged 25 to 84 years with no previous MI. The subjects were followed for 6 years and incident MI was registered.

Results— During follow-up, MI occurred in 6.6% of men and 3.0% of women. The adjusted relative risk (RR; 95% CI) between the highest plaque area tertile versus no plaque was 1.56 (1.04 to 2.36) in men and 3.95 (2.16 to 7.19) in women. In women, there was a significant trend toward a higher MI risk with more echolucent plaque. The adjusted RR (95% CI) in the highest versus lowest IMT quartile was 1.73 (0.98 to 3.06) in men and 2.86 (1.07 to 7.65) in women. When we excluded bulb IMT from analyses, IMT did not predict MI in either sex.

Conclusions— In a general population, carotid plaque area was a stronger predictor of first-ever MI than was IMT. Carotid atherosclerosis was a stronger risk factor for MI in women than in men. In women, the risk of MI increased with plaque echolucency.

Key Words: carotid arteries - echogenicity - epidemiology - myocardial infarction - plaque - sex - ultrasonics

Stroke. 2007;38:2873-2880