From the Guidelines
Plaque erosion is more commonly seen in young women due to their unique cardiovascular physiology and hormonal environment, as evidenced by a recent study published in 2023 1. This is attributed to several factors, including the role of estrogen in affecting vascular endothelial function and inflammatory responses. Young women typically have higher levels of estrogen, which can influence the composition of arterial plaques, making them more prone to erosion rather than rupture. Some key points to consider include:
- Women are more likely to have myocardial infarction from plaque erosion, spontaneous coronary artery dissection, and nonobstructive coronary arteries than men 1.
- The presence of certain autoimmune conditions, which are more prevalent in women, may also contribute to endothelial damage and subsequent plaque erosion.
- Women often experience different patterns of atherosclerosis, with more diffuse disease and microvascular dysfunction, as noted in a study published in the same year 1. These factors collectively explain why plaque erosion, rather than plaque rupture, is the predominant mechanism of acute coronary syndromes in younger female patients, particularly those under 50 years of age. In terms of specific data, an autopsy study that included 442 cases of ACS found that plaque erosion was more common in women compared with men (58% versus 24%), whereas plaque rupture was found to be more common in men than women (71% versus 33%) 1. Overall, the current evidence suggests that plaque erosion is a significant concern in young women, and further research is needed to understand the underlying mechanisms and develop effective prevention and treatment strategies.
From the Research
Plaque Erosion in Young Women
- Plaque erosion is more common in younger women (< 50 years) and smokers, according to a study published in 2024 2.
- The study found that plaque erosion is characterized by a defective endothelial layer in the intima, promoting thrombus formation in the presence of an intact fibrous cap.
- Another study published in 2020 found that females aged ≤ 70 had an increased risk of plaque erosion, with an odds ratio of 2.138 (95% CI 1.249-3.661, p = 0.006) 3.
- The same study found that the prevalence of plaque erosion was similar between males and females, but that males aged ≤ 50 had a higher prevalence of plaque erosion.
- A study published in 2024 found that risk factors for plaque erosion include gender, age, smoking, and disturbances in shear flow 2.
- The study also discussed advances in pathogenic and molecular mechanisms, such as endothelial shear stress, neutrophil activation, and toll-like receptor-2 pathways, which may contribute to plaque erosion.
Comparison with Other Studies
- Other studies, such as those published in 2011,2019, and 2024, focused on dental erosion and the effects of fluoride on dental caries, rather than plaque erosion in coronary arteries 4, 5, 6.
- These studies found that fluoride can strengthen teeth against erosive acid damage and reduce the risk of dental caries, but did not provide direct evidence on plaque erosion in young women.
- Therefore, the evidence from studies 2 and 3 suggests that plaque erosion is more common in young women due to a combination of factors, including gender, age, and lifestyle factors such as smoking.