Recent Advances in CardiologyEffect of menopause on plaque morphologic characteristics in coronary atherosclerosis☆,☆☆,★
Section snippets
Case selection
Women who died suddenly were evaluated prospectively in consultation, as previously reported.13 This study included 51 previously reported cases of sudden coronary death (Table I)13 and 47 deaths (control group) in women who died from noncoronary causes studied during the same period (Table II). In addition, nonculprit coronary plaque morphologic characteristics were compared between women <50 years and women >50 years.
Examination of the heart and determination of type of death
Hearts were perfusion-fixed in buffered formalin, and epicardial arteries
Correlation of risk factors with culprit plaque morphologic characteristics
This dataset was composed of 51 women who died suddenly with acute coronary artery disease and 47 control subjects. Women older than 50 years were much more likely to have a ruptured plaque than were younger, premenopausal women (Table I). Plaque rupture was associated with elevated total cholesterol, body mass index, and elevated glycosylated hemoglobin by univariate analysis (Table I). Plaque erosions, which occurred most frequently in premenopausal women, were associated with cigarette
Discussion
We have demonstrated significant differences in the plaque morphologic characteristics of premenopausal women versus older women who died suddenly from coronary artery disease. The culprit plaque in premenopausal women rarely appeared ruptured; in those few young women with plaque rupture, serum total cholesterol level was severely elevated. Because the major cause of coronary thrombosis in men and postmenopausal women is plaque rupture, the protective effects of estrogen may lie largely in its
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Supported in part by research grant RO1HL61799-02 from the National Institutes of Health.
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The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army, the Department of the Air Force, or the Department of Defense.
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Reprint requests: Renu Virmani, MD, Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000. E-mail: [email protected]