Arteriosclerosis, Thrombosis, and Vascular Biology. 1999;19:3007-3013
© 1999 American Heart Association, Inc.
Atherosclerosis and Lipoproteins |
Age and Sex Differences in the Distribution and Ultrasound Morphology of Carotid Atherosclerosis
The Tromsø Study
Abstract—Atherosclerosis begins early in life and is the major underlying cause of cardiovascular morbidity and death. Yet, population-based information on age and sex differences in the extent and morphology of atherosclerosis throughout life is scarce. Carotid atherosclerosis can be visualized with B-mode ultrasound and is a marker of atherosclerosis elsewhere in the circulation. We assessed both the prevalence and the morphology of carotid atherosclerosis by B-mode ultrasound in 3016 men and 3404 women, 25 to 84 years old, who participated in a population health survey. The participation rate was 88%. Plaque morphology was graded according to whether a plaque was predominantly soft (echolucent) or hard (echogenic). Atherosclerotic plaques were found in 55.4% of the men and 45.8% of the women. In men, there was a linear increase with age in the prevalence of carotid atherosclerosis, whereas in women, there was a curvilinear age trend, with an inflection in the prevalence rate of women at
50 years of age. The male predominance in
atherosclerosis declined after the age of 50 years, the
plaque prevalence being similar in elderly men and women. Men had
softer plaques than women; this sex difference in plaque morphology
increased significantly (P=0.005) with age. The sex
difference in the prevalence of atherosclerosis and the
female age trend in atherosclerosis show significant
changes at the age of 50 years, suggesting an adverse effect of
menopause on atherosclerosis. The higher proportion of
soft plaques in men compared with women increases with age and may
partly account for the prevailing male excess risk of coronary
heart disease in the elderly despite a similar prevalence of
atherosclerosis in elderly men and women.
Key Words: ultrasonography • carotid arteries • atherosclerosis • sex
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