Sex-Related Differences in the Incidence and Development of Carotid Plaques in a Low-Income Chinese Population—A Prospective Cohort Study

Abstract

Yunpeng Lin,1,* Yan Li,2,3,* Zhiying Li,4,* Zhen Zhang,5 Jie Liu,3,6– 8 Jiayi Sun,5 Jun Tu,3,6– 8 Jinghua Wang,3,6– 8 Wenjuan Zhang,5 Jidong Li,2,9 Xianjia Ning3,6– 8 1Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China; 2Department of Anesthesiology, Tianjin Jizhou People’s Hospital, Tianjin, 301900, People’s Republic of China; 3Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People’s Hospital, Tianjin, 301900, People’s Republic of China; 4Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine & National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, People’s Republic of China; 5Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China; 6Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China; 7Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China; 8Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of China; 9Department of Neurosurgery, Tianjin Jizhou People’s Hospital, Tianjin, 301900, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xianjia Ning, Department of Neurology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People’s Republic of China, Tel [phone], Fax [phone], Email [email protected] Jidong Li, Department of Neurosurgery, Tianjin Jizhou People’s Hospital, 18 Nanhuan Road, Jizhou District, Tianjin, 301900, People’s Republic of China, Tel/Fax [phone], Email [email protected]: More than 150 million people are estimated to have been examined for the presence of carotid plaques (CPs) in China; a sex-related imbalance in the prevalence exists. However, the relationship between sex and the incidence of CP development is unclear, especially in low-income areas of China. Hence, this study aimed to identify the sex differences in CP development and CP burden in both sexes in this population.Methods: The study population included individuals aged ≥ 45 years in a rural area of Tianjin, China. Carotid ultrasonography was performed in the 2014 and 2019 cohorts, and information on carotid ultrasonography, including the formation and number of CPs, was collected twice. Logistic analyses were used to investigate the predictors of CP formation and numbers of plaques.Results: A total of 1479 participants were analyzed. The incidence of CP was 20.3% and 29.0% in women and men, respectively. In women, high low-density lipoprotein cholesterol (LDL-C) levels was independent predictors of CP formation (RR: 1.217, 95%CI: 1.010, 1.461; P=0.039). For men, the corresponding predictors were hypertension, alcohol consumption, and low high-density lipoprotein cholesterol (HDL-C) levels (all P< 0.05); none of the examined factors were associated with plaque numbers.Conclusion: In the study population, men had a higher incidence of plaque than women. Predictors of CP are different in men and women. LDL-C control is critical for moderating atherosclerosis in women; in men, managing blood pressure, stopping alcohol consumption, and controlling HDL-C levels are important.Keywords: atherosclerosis, carotid plaque, sex differences, predictors, prospective study

Keywords

• atherosclerosis
• carotid plaque
• sex differences
• predictors
• prospective study.