Background—: Numerous reports suggest sex-related differences in atherosclerosis. Frequency-domain optical coherence tomography has enabled visualization of plaque microstructures associated with disease instability. The prevalence of plaque microstructures between sexes has not been characterized. We investigated sex differences in plaque features in patients with coronary artery disease. Methods and Results—: Nonculprit plaques on frequency-domain optical coherence tomography imaging were compared between men and women with either stable coronary artery disease (n=320) or acute coronary syndromes (n=115). A greater prevalence of cardiovascular risk factors was observed in women. Nonculprit plaques in women with stable coronary artery disease were more likely to exhibit plaque erosion (8.6% versus 0.3%; P =0.03) and a smaller lipid arc (163.1±71.4° versus 211.2±71.2°; P =0.03), and less likely to harbor cholesterol crystals (17.2% versus 27.5%; P =0.01) and calcification (15.4% versus 34.4%; P =0.008), whereas fibrous cap thickness (105.2±62.1 versus 96.1±40.4 µm; P =0.57), the prevalence of thin-cap fibroatheroma (26.5% versus 25.2%; P =0.85), and microchannels (19.2% versus 20.5%; P =0.95) were comparable. In women with acute coronary syndrome, a smaller lipid arc (171.6±53.2° versus 235.8±86.4°; P =0.03), a higher frequency of plaque erosion (11.4% versus 0.6%; P =0.04), and a lower prevalence of cholesterol crystal (28.6% versus 38.2%; P =0.03) and calcification (10.0% versus 23.7%; P =0.01) were observed. These differences persisted after adjusting clinical demographics. Although thin-cap fibroatheromas in men clustered within proximal arterial segments, thin-cap fibroatheromas were evenly distributed in women. Conclusions—: Despite more comorbid risk factors in women, their nonculprit plaques exhibited more plaque erosion, and less cholesterol and calcium content. This distinct phenotype suggests sex-related differences in the pathophysiology of atherosclerosis.

Editorial: Challenges in implementing digital health in public health settings in low and middle income countries

Obesity is associated with adverse atherosclerotic cardiovascular events. While various metabolic abnormalities associated with obesity promote plaque formation, the morphological phenotype of atherosclerotic plaque has not been well characterized in the setting of obesity. Frequency-domain optical coherence tomography (FD-OCT) enables in vivo visualization of plaque microstructures associated with vulnerability. We characterized plaque microstructures in obese patients. FD-OCT imaging was performed in 308 patients with coronary artery disease undergoing percutaneous coronary intervention. Patients were stratified according to the presence or absence of obesity (body mass index > 30 kg/m²). Plaques in obese (n = 129) and non-obese (n = 179) patients were compared with regard to clinical characteristics and FD-OCT-derived features of plaque vulnerability. Obese patients were more likely to be younger (p = 0.01), female (p = 0.01) and have a history of hypertension (p = 0.01). Higher levels of triglyceride (p < 0.0001) and glucose (p = 0.02), whereas a lower level of high-density lipoprotein cholesterol (HDL-C) (p = 0.02) was observed in obese patients. FD-OCT imaging demonstrated thinner fibrous caps (85.3 ± 31.1 vs 110.1 ± 32.4 µm, p = 0.01) and a higher prevalence of thin-cap fibroatheroma (28.8 vs 14.3%, p = 0.01) in obese patients, which remained significant after controlling for differences in clinical characteristics. Achieving a low-density lipoprotein cholesterol (LDL-C) level < 1.8 mmol/l was associated with thicker fibrous caps in obese patients, but only to the level observed in non-obese patients with suboptimal lipid control. Obese patients harbor more vulnerable plaques in association with atherogenic risk factors. The limited benefit of lipid control suggests the need to adopt novel anti-atherosclerotic strategies in higher-risk patients.

Purpose of Review: Cardiovascular diseases remain the foremost cause of mortality globally. As molecular medicine unravels the alterations in genomic expression and regulation of the underlying atherosclerotic process, it opens new vistas for discovering novel diagnostic biomarkers and therapeutics for limiting the disease process. miRNAs have emerged as powerful regulators of protein translation by regulating gene expression at the post-transcriptional level. Recent findings: Overexpression and under-expression of specific miRNAs are being evaluated as a novel approach to diagnosis and treatment of cardiovascular disease. This review sheds light on the current knowledge of the miRNA evaluated in cardiovascular disease. Conclusion: In this review we summarize the data, including the more recent data, regarding miRNAs in cardiovascular disease and their potential role in future in diagnostic and therapeutic strategies.