Rationale: Sex steroids may play a role in plaque composition and in stroke incidence.

Objectives: To study the associations of endogenous estradiol and testosterone with carotid plaque composition in elderly men and postmenopausal women with carotid atherosclerosis, as well as with risk of stroke in this population.

Methods and Results: Data of 1023 postmenopausal women and 1124 men (≥45 years) with carotid atherosclerosis, from prospective population-based RS (Rotterdam Study), were available. At baseline, total estradiol (TE) and total testosterone (TT) were measured. Carotid atherosclerosis was assessed by ultrasound, whereas plaque composition (presence of calcification, lipid core, and intraplaque hemorrhage) was assessed by magnetic resonance imaging. TE and TT were not associated with calcified carotid plaques in either sex. TE was associated with presence of lipid core in both sexes (in women odds ratio, 1.48 [95% confidence interval [CI], 1.02–2.15]; in men odds ratio, 1.23 [95% CI, 1.03–1.46]), whereas no association was found between TT and lipid core in either sex. Higher TE (odds ratio, 1.58 [95% CI, 1.03–2.40]) and lower TT (odds ratio, 0.82 [95% CI, 0.68–0.98]) were associated with intraplaque hemorrhage in women but not in men. In women, TE was associated with increased risk of stroke (hazard ratio, 1.98 [95% CI, 1.01–3.88]), whereas no association was found in men. TT was not associated with risk of stroke in either sex.

Conclusions: TE was associated with presence of vulnerable carotid plaque as well as increased risk of stroke in women, whereas no consistent associations were found for TT in either sex.

理由：性类固醇可能在斑块组成和中风发病中起作用。

目的：研究内源性雌二醇和睾丸激素与老年男性和绝经后患有颈动脉粥样硬化的妇女的颈动脉斑块组成的关系，以及该人群中风的风险。

方法和结果：从基于人群的前瞻性RS（鹿特丹研究）获得了1023名绝经后女性和1124名男性（≥45岁）的颈动脉粥样硬化的数据。在基线时，测量总雌二醇（TE）和总睾丸激素（TT）。通过超声评估颈动脉粥样硬化，而通过磁共振成像评估斑块组成（钙化，脂质核心和斑块内出血的存在）。无论男女，TE和TT均与钙化的颈动脉斑块无关。性别与脂质核心的存在相关（女性比值比为1.48 [95％置信区间[CI]，1.02–2.15]；男性比值比为1.23 [95％CI，1.03–1.46]），而在任何性别中，TT和脂质核心之间均未发现关联。较高的TE（赔率，1.58 [95％CI，1.03–2.40]）和较低的TT（赔率，0.82 [95％CI，0.68-0]。[98]]与女性斑块内出血有关，而与男性无关。在女性中，TE与中风风险增加相关（危险比1.98 [95％CI，1.01-3.88]），而在男性中则没有相关性。TT与两性中风的风险均无关。

结论： TE与女性易患颈动脉斑块的存在以及中风的风险增加相关，而在男女中均未发现TT具有一致的关联性。