There are notable sex differences in cardiovascular disease. Although the cumulative incidence of cardiovascular disease in women lags behind that of men by ≈7 to 10 years, strokes comprise a larger proportion of cardiovascular events in women than in men.1 In terms of clinical impact, aspirin used for primary prevention is associated with a significance reduction in stroke women but not myocardial infarction in men.2 Differences in endogenous sex hormones have been hypothesized to underlie these substantial sex differences, but clinical data are limited on the relationship between endogenous levels and cardiovascular disease occurrence. Article, see p 97 In this issue, Glisic et al3 examine the relationship of endogenous sex hormone levels and carotid plaque composition, as well as incident stroke, in >2100 older men and women in the Rotterdam Study. Notably, presence of carotid atherosclerosis (carotid intimal–medial thickness of >2.0 mm on carotid screening) was more common among men than women in the study. Among those with established atherosclerosis, the prevalence of calcified plaques was similar in men and women, whereas women were less likely to have a lipid core (36.9% of women; 49.5% of men) and less likely to have intraplaque hemorrhage than men (29.0% of women; 40.0% of men). Endogenous hormones, specifically estradiol and testosterone, were correlated with carotid plaque composition. Higher estradiol levels were associated with increased odds of a lipid core in carotid plaque in both men and women. Women with detectable estradiol levels had a 58% increased odds of having intraplaque hemorrhage compared with women with low estradiol, whereas higher total testosterone levels were associated with decreased odds. No relationship was observed for total testosterone and carotid plaque composition features in men.3 Endogenous hormones were also related to incident stroke in women. Among women with carotid plaque, …

中文翻译：

---

性激素，颈动脉粥样硬化和中风的性别差异

心血管疾病存在明显的性别差异。尽管女性心血管疾病的累积发病率比男性要低约7至10岁，但中风在女性心血管疾病中所占的比例要比男性高。1就临床影响而言，用于一级预防的阿司匹林与2内源性激素的差异被认为是这些实质性差异的基础，但临床数据仅限于内源性水平与心血管疾病发生之间的关系。文章，请参阅第97页。在此问题中，Glisic等[3]在以下文章中检查了内源性激素水平与颈动脉斑块组成以及中风的关系：鹿特丹研究中有2100名年龄较大的男人和女人。值得注意的是，在研究中，男性比女性更常见颈动脉粥样硬化（颈动脉筛查时颈动脉内膜-中膜厚度> 2.0 mm）。在已确诊的动脉粥样硬化患者中，男女钙化斑块的患病率相似，而与女性相比，女性更不容易出现脂质核心（女性占36.9％；男性占49.5％），斑块内出血的可能性较小（29.0）女性的百分比；男性的40.0％）。内源性激素，特别是雌二醇和睾丸激素，与颈动脉斑块成分有关。男性和女性中较高的雌二醇水平与颈动脉斑块中脂质核心几率的增加相关。与雌二醇含量低的女性相比，可检测到雌二醇含量的女性斑块内出血的几率增加了58％，而总睾丸激素水平升高与几率降低有关。男性的总睾丸激素和颈动脉斑块组成特征没有相关性。3内源性激素也与女性中风有关。在患有颈动脉斑块的女性中，...