Carotid plaque offsets the sex difference in cardiovascular risk in young to middle age hypertensive patients: the campania salute network

Objective: The aim of the present study is to assess whether presence of carotid artery plaque (CP) has a similar impact on the sex difference in risk for future cardiovascular events. Design and method: we studied 5209 women and men <65 years old with hypertension and free from prevalent cardiovascular disease enrolled in the prospective Campania Salute Network registry were followed over a mean of 5.9 years. Subjects were grouped according to the absence or the presence of CP identified by Doppler ultrasound (intima-media thickness>15mm). Main outcome was major cardiovascular events (MACE; combined acute coronary syndromes, stroke, hospitalization for heart failure and incident atrial fibrillation). Results: Among patients without CP (n = 3139), women were older, with higher systolic BP, cholesterol level and prevalent LVH but lower triglycerides and eGFR, compared to men (all p<0.001). Among patients with CP (n = 2070), women were older, taking higher number of antihypertensive drug, with higher cholesterol level and prevalent LVH but lower triglycerides and eGFR compared to men (all p<0.001). In Cox regression analysis adjusting for cardiovascular risk factors, LVH and antihypertensive treatment during follow up women without CP had lower hazard rate (HR = 0.41) for MACE (n = 107) than men (95% confidence interval [CI] 0.39–0.89, p = 0.01). In contrast, among patients with CP, women had similar HR for MACE (n = 132) as men (HR 0.79 [95% CI 0.54–1.14], p = 0.203). Conclusions: This study demonstrates that presence of carotid organ damage in hypertension contributes to offset the female sex-protection in cardiovascular risk. Thus, expanding previous finding, young to middle-age women and men with hypertension and carotid organ damage have comparable cardiovascular risk.