Carotid artery disease: Do women present differently than men?

Abstract Stroke is a significant cause of morbidity and mortality in both women and men worldwide. Because women with acute myocardial infarction may present with atypical symptoms, they also present with nontraditional, more generalized symptoms when experiencing an acute ischemic stroke compared with men. Despite having better knowledge of stroke signs and symptoms, women tend to present to hospital later than men. Women with carotid disease are less likely to be prescribed antiplatelet medication. The pathophysiology of carotid disease is also different between men and women because women have more stable and less inflammatory plaque compared with men. Women often present with higher-grade carotid stenosis, and men have been found to have a higher burden of plaque. The effect of hormones and hormone replacement therapy (HRT) on atherosclerosis is not completely understood; however, it has been shown that as age increases, HRT has worse effects on stroke, transient ischemia attacks, and systemic embolism. The differences in carotid artery disease between men and women are multifaceted and complex, involving factors such as pathophysiology, anatomy, hormonal, and social factors. An improved understanding of the complex nature of carotid disease in women and how it differs from men will lead to better outcomes.