Impact of gender on the density of intraplaque neovascularization: a quantitative contrast-enhanced ultrasound study.

Objective: Atherosclerosis is the main underlying cause of the majority of cardiovascular events. Although cardiovascular diseases (CVD) are a major challenge in both males and females, gender specific differences in the prevalence of CVD have been observed. This may indicate that there are differences in the development of atherosclerosis between males and females. The presence of intraplaque neovessels (IPN) is an imaging marker for plaque vulnerability. The aim of this study was to investigate the impact of gender on IPN.

Methods: A total of 159 patients with ≥1 cardiovascular risk factor were included in this prospective study (mean age 56.9±8.7 years, 47% females). Patients had no symptoms of carotid atherosclerotic disease. All patients underwent a standard carotid ultrasound examination in conjunction with contrast-enhanced ultrasound (CEUS). The presence of atherosclerotic plaques was assessed according to the Mannheim consensus. IPN was assessed using a visual grading scale and semi-automated quantification software.

Results: Subclinical atherosclerosis was detected using standard carotid ultrasound and CEUS in 64 females (86%) and in 79 males (93%) (p=0.177). The mean atherosclerotic plaque sizes were not significantly different (p=0.068). Semi-automated quantification of IPN demonstrated that females had significant more IPN compared to males (p<0.05). After adjustment for clinical variables this association remained significant (p<0.05).

Conclusion: In this population at increased risk for CVD, females had significantly more IPN compared to males. This suggests that the females had a more vulnerable atherosclerotic plaque type.