Ricerc@Sapienza

Carotid atherosclerosis is a risk factor for ischemic stroke, the third cause of death in developed countries. Degree of stenosis, evaluated by imaging techniques, is used to predict the risk of future cerebrovascular events and it is considered the most validated parameter to select asymptomatic patients eligible for carotid endarterectomy. However it has been observed that a subset of patients, particularly women, with lesions at an early stage of development undergoes sudden death. Therefore there is the need of more sensitive tools, that in addition to imaging techniques permit to identify plaques at high risk of clinical events. Sex differences have been observed in plaque composition as well as in stroke incidence. Women have higher rates of stable atherosclerotic plaques, whereas unstable lesions are more frequent in men. Nevertheless, in women the risk for stroke roughly doubles during the 10 years after menopause. Data exist indicating that sex hormones may have a role in plaque composition and in ischemic stroke occurrence. Experimental evidence suggests that estradiol is associated with the presence of vulnerable carotid plaque and increased risk of stroke in women. Furthermore, clinical studies suggest that circulating levels of testosterone are inversely associated to intima-media thickness of carotid arteries in men whereas decreased levels of sex hormone-binding globulin represent a risk factor for cardiovascular diseases in both women and men. The aim of this project is to evaluate whether the determination of serum estradiol, testosterone and sex hormone-binding globulin in patients with carotid atherosclerosis could provide a useful adjunctive criterion to ensure a better risk stratification and to identify, in combination with imaging techniques, high risk- plaques eligible for endarterectomy. Gender differences will be taken into account to determine the role of sex hormones as suitable biomarkers of plaque vulnerability.