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(Stroke. 2001;32:1953.)
© 2001 American Heart Association, Inc.

Original Contributions

Site-Specific Atherosclerotic Plaques in the Carotid Arteries of Middle-Aged Women From Southern Italy

Associations With Traditional Risk Factors and Oxidation Markers

Paolo Rubba, MD; Salvatore Panico, MD; M. Gene Bond, PhD; Giuseppe Covetti, MD; Egidio Celentano, MD; Arcangelo Iannuzzi, MD; Rocco Galasso, MD; M. Antonietta Belisario, PhD; Antonella Pastinese, PhD; Lucia Sacchetti, PhD; Mario Mancini, MD Francesco Salvatore, MD

From the Dipartimento di Medicina Clinica e Sperimentale (P.R., S.P., G.C., A.I., M.M.) and Dipartimento di Biochimica e Biotecnologie Mediche (M.A.B., A.P., L.S., F.S.), Facolta’ di Medicina e Chirurgia, Universita’ di Napoli Federico II, Naples, Italy; Unita’ di Epidemiologia, Istituto Nazionale per la Ricerca sul Cancro, Naples, Italy (E.C.); Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Potenza, Italy (R.G.); and Division of Vascular Ultrasound Research, School of Medicine, Wake Forest University, Winston-Salem, NC (M.G.B.).

Reprint requests to Paolo Rubba, MD, Clinica Medica, Policlinico, Facolta’ di Medicina e Chirurgia, Universita’ di Napoli Federico II, Via S. Pansini 5, 80131 Naples, Italy. E-mail rubba{at}unina.it

Background and Purpose—— Studies on cardiovascular disease have preferentially involved men because of the lower frequency of the disease in preelderly women. The aim of this analysis was to examine, with the use of a standardized ultrasound protocol, a cohort of women to differentiate early atherosclerotic lesions in different carotid segments in relation to traditional (lipoprotein abnormalities, high blood pressure, cigarette smoking) and nontraditional (oxidation markers) cardiovascular risk factors.

Methods—— More than 5000 clinically healthy, middle-aged women (n=5062; age range, 30 to 69 years) living in the area of Naples in southern Italy participated in the Progetto Atena, a population-based study on the etiology of cardiovascular disease and cancer in the female population. A subsample of 310 participants underwent high-resolution B-mode ultrasound to assess intima-media thickness of common carotid artery and carotid bifurcation.

Results—— Early atherosclerotic plaques (intima-media thickness >1.2 mm) were detected within the common carotid arteries in 37 women, in the carotid bifurcations in 77 women, and in both sites in 91 women. After age adjustment, common carotid plaques were found to be associated with higher systolic blood pressure (143 versus 138 mm Hg; P<0.05) and higher body mass index (29 versus 27 kg/m²; P<0.01), while lesions at the carotid bifurcations were associated with higher LDL cholesterol (4.3 versus 3.8 mmol/L; P<0.01) and with smoking habit. Multivariate odds ratios for the presence of common carotid plaques were related to antibodies against oxidized LDL (odds ratio, 2.72; 95% CI, 1.46 to 5.07), and those for plaques at the bifurcation were related to lipid peroxides (odds ratio, 1.90; 95% CI, 1.04 to 3.47), and both relationships were independent of age, LDL cholesterol concentrations, body mass index, smoking habit, and systolic blood pressure.

Conclusions—— In a cohort of clinically healthy, middle-aged women, we found a site-specific association of traditional risk factors and oxidation markers with early atherosclerotic lesions in arterial segments differing in geometry, shear stress, extracellular matrix composition, and cell type populations.

Key Words: atherosclerosis • oxidized low density lipoprotein • risk factors • ultrasonics • women

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