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From the Departments of Epidemiology (K.S.-T., H.C.L., C.B., K.A.M.,
L.H.K.) and Psychiatry (K.A.M.), Graduate School of Public Health, University
of Pittsburgh, Pittsburgh, Pa, and the London School of Hygiene and Tropical
Medicine, London, England (E.M.).
Correspondence to Kim Sutton-Tyrrell, DrPH, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto St, Pittsburgh, PA 15261. E-mail Tyrrell{at}edc.gsph.pitt.edu
Background and Purpose—In women,
symptoms of coronary artery disease are delayed by 10 to 15
years in comparison with men, most likely because of the protective
effect of ovarian hormones. This report compares the prevalence
and degree of carotid atherosclerosis between 292
premenopausal women and 294 women at 5 to 8 years after menopause.
Methods—Scans were performed in the same laboratory over the same
time period for both groups. Intima-media thickness (IMT) was averaged
across the common, bulb, and internal carotids. The plaque index
summarized degree of focal plaque based on the size and number of
plaques throughout both carotid systems.
Results—Mean IMT was 0.69 mm for premenopausal women and
0.77 mm for postmenopausal women (P<0.001).
Prevalence of plaque was 25% among premenopausal women and 54% among
postmenopausal women (P<0.001). In both premenopausal
and postmenopausal women, risk factors measured before menopause were
associated with carotid atherosclerosis. Premenopausal
risk factors independently associated with IMT were higher pulse
pressure (P<0.001), triglycerides
(P=0.002), body mass index (P<0.001),
and study group (a surrogate for both age and menopausal status;
P<0.001). Premenopausal risk factors independently
associated with focal plaque were ever smoking
(P=0.002), higher pulse pressure
(P=0.028), higher LDL (P=0.003), age at
baseline (P=0.050), and study group
(P<0.001).
Conclusions—Subclinical carotid atherosclerosis
can be observed in middle-aged women. Risk factors measured before
menopause are clearly associated with subclinical disease measured both
concurrently and at 5 to 8 years after menopause.
© 1998 American Heart Association, Inc.
Original Contributions
Carotid Atherosclerosis in Premenopausal and Postmenopausal Women and Its Association With Risk Factors Measured After Menopause
Key Words: atherosclerosis • carotid artery diseases • epidemiology • women
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