Sex differences in features of atherosclerotic plaques as revealed by various imaging techniques: historical review

Numerous studies over several decades found that there are significant sex differences in the development and severity of atherosclerosis, which include plaque burden, composition and vulnerability to rupture. This review provides historical analysis of these studies starting with early histological...

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Main Authors: Dalya Laban, Alice Kattan, Lamia Ait-Abdellah, Hema Krishna, Elizabeth Le Master, Irena Levitan
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-05-01
Series:Frontiers in Physiology
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Online Access:https://www.frontiersin.org/articles/10.3389/fphys.2025.1579885/full
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author Dalya Laban
Alice Kattan
Lamia Ait-Abdellah
Hema Krishna
Hema Krishna
Elizabeth Le Master
Irena Levitan
author_facet Dalya Laban
Alice Kattan
Lamia Ait-Abdellah
Hema Krishna
Hema Krishna
Elizabeth Le Master
Irena Levitan
author_sort Dalya Laban
collection DOAJ
description Numerous studies over several decades found that there are significant sex differences in the development and severity of atherosclerosis, which include plaque burden, composition and vulnerability to rupture. This review provides historical analysis of these studies starting with early histological analysis of post mortem samples to modern high-resolution imaging techniques. It is discussed that the abundance of evidence obtained by an array of approaches demonstrates that men are more prone to develop atherosclerosis, which manifests itself in earlier initiation of the plaques, while the occurrence of plaque is accelerated following menopause. These findings unequivocally show that men are more likely to develop plaques with larger lipid-rich necrotic cores, thinner fibrous caps, and stronger inflammatory responses, resulting in increased vulnerability at a younger age. However, the rapid escalation of plaque instability in postmenopausal women, which is caused by a significant reduction in smooth muscle cell density and changes in calcification patterns, results in comparable atherosclerotic burden in men and women in older adults. These findings highlight how differences in sex and age, influence the development and severity of atherosclerosis. Understanding these differences is essential for creating better ways to assess and treat heart disease in men and women.
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publisher Frontiers Media S.A.
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spelling doaj-art-3f27ee5cca1b43afa9da4cdb6f9b8dc62025-08-20T02:29:35ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2025-05-011610.3389/fphys.2025.15798851579885Sex differences in features of atherosclerotic plaques as revealed by various imaging techniques: historical reviewDalya Laban0Alice Kattan1Lamia Ait-Abdellah2Hema Krishna3Hema Krishna4Elizabeth Le Master5Irena Levitan6Division of Pulmonary and Critical Care, University of Illinois at Chicago, Chicago, IL, United StatesDivision of Pulmonary and Critical Care, University of Illinois at Chicago, Chicago, IL, United StatesDivision of Pulmonary and Critical Care, University of Illinois at Chicago, Chicago, IL, United StatesDivision of Cardiology, University of Illinois at Chicago, Chicago, IL, United StatesJesse Brown VA Medical Center, Chicago, IL, United StatesDivision of Pulmonary and Critical Care, University of Illinois at Chicago, Chicago, IL, United StatesDivision of Pulmonary and Critical Care, University of Illinois at Chicago, Chicago, IL, United StatesNumerous studies over several decades found that there are significant sex differences in the development and severity of atherosclerosis, which include plaque burden, composition and vulnerability to rupture. This review provides historical analysis of these studies starting with early histological analysis of post mortem samples to modern high-resolution imaging techniques. It is discussed that the abundance of evidence obtained by an array of approaches demonstrates that men are more prone to develop atherosclerosis, which manifests itself in earlier initiation of the plaques, while the occurrence of plaque is accelerated following menopause. These findings unequivocally show that men are more likely to develop plaques with larger lipid-rich necrotic cores, thinner fibrous caps, and stronger inflammatory responses, resulting in increased vulnerability at a younger age. However, the rapid escalation of plaque instability in postmenopausal women, which is caused by a significant reduction in smooth muscle cell density and changes in calcification patterns, results in comparable atherosclerotic burden in men and women in older adults. These findings highlight how differences in sex and age, influence the development and severity of atherosclerosis. Understanding these differences is essential for creating better ways to assess and treat heart disease in men and women.https://www.frontiersin.org/articles/10.3389/fphys.2025.1579885/fullcardiovascular diseasevascular biologyplaque stabilityfibrous cap thinningsex differences
spellingShingle Dalya Laban
Alice Kattan
Lamia Ait-Abdellah
Hema Krishna
Hema Krishna
Elizabeth Le Master
Irena Levitan
Sex differences in features of atherosclerotic plaques as revealed by various imaging techniques: historical review
Frontiers in Physiology
cardiovascular disease
vascular biology
plaque stability
fibrous cap thinning
sex differences
title Sex differences in features of atherosclerotic plaques as revealed by various imaging techniques: historical review
title_full Sex differences in features of atherosclerotic plaques as revealed by various imaging techniques: historical review
title_fullStr Sex differences in features of atherosclerotic plaques as revealed by various imaging techniques: historical review
title_full_unstemmed Sex differences in features of atherosclerotic plaques as revealed by various imaging techniques: historical review
title_short Sex differences in features of atherosclerotic plaques as revealed by various imaging techniques: historical review
title_sort sex differences in features of atherosclerotic plaques as revealed by various imaging techniques historical review
topic cardiovascular disease
vascular biology
plaque stability
fibrous cap thinning
sex differences
url https://www.frontiersin.org/articles/10.3389/fphys.2025.1579885/full
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