• Costantino Mancusi, Christian Basile, Eva Gerdts, Ilaria Fucile, Maria Virginia Manzi, Maria Lembo, Daniela Pacella, Giuseppe Giugliano, Grazia Canciello, Raffaele Piccolo, Alessandra Spinelli, Carmine Morisco, Nicola De Luca, Bruno Trimarco, Giovanni de Simone, Eduardo Bossone, Raffaele Izzo, Maria Angela Losi, and Giovanni Esposito.
• Hypertension Research Center and Department of Advanced Biomedical Science, Federico II University, Naples, Italy.
• Eur. J. Intern. Med. 2024 Sep 17.

BackgroundWomen have a lower risk for cardiovascular (CV) disease compared to men. Whether this difference is influenced by the presence of hypertension-mediated organ damage is unknown.ObjectiveTo assess whether the presence of carotid plaque (CP) impacts the sex difference in risk for CV events in treated hypertensive patients.MethodsFrom the Campania Salute Network Registry 2419 women and men <51 years of age with treated hypertension and free from prevalent CV disease were included. The presence of CP was identified by Doppler ultrasound (intima-media thickness≥1.5 mm). The primary outcome was a composite of fatal and non-fatal stroke or myocardial infarction, sudden death, TIA, myocardial revascularization, de novo angina, and atrial fibrillation.ResultsAmong patients without CP at baseline (n = 1807), women were older, with higher systolic blood pressure, serum cholesterol level and prevalence of LVH but lower serum triglycerides and eGFR, compared to men (all p < 0.001). Among patients with CP (n = 612), women were older, used higher number of antihypertensive drugs, had higher serum cholesterol level and prevalence of left ventricular hypertrophy (LVH), but had lower serum triglycerides and eGFR compared to men (all p < 0.001). During follow-up, women without CP had a lower risk for CV disease than men (hazard ratio, HR, 0.51, 95 % confidence intervals, CI, 0.27-0.99, p = 0.04) after accounting for cardiovascular risk factors, LVH, and antihypertensive treatment. In contrast, among patients with CP, women had similar risk for CV disease compared with men (HR 1.3, 95 % CI, 0.59-2.9, p = 0.48).ConclusionsOur findings suggest that the presence of CP in young patients with treated hypertension offsets the CV disease protection in women.Trial RegistrationNCT02211365.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.

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