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Subclinical atherosclerosis in multiple vascular beds: an index of atherosclerotic burden evaluated in postmenopausal women

  • Kim Sutton-Tyrrell
    Correspondence
    Corresponding author. Tel.: +1-412-624-7875; fax: +1-412-624-3775
    Affiliations
    Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA
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  • Lewis H Kuller
    Affiliations
    Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA
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  • Karen A Matthews
    Affiliations
    Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA

    Department of Psychiatry and Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
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  • Richard Holubkov
    Affiliations
    Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA

    Divisions of Cardiology, University of Pittsburgh, 120 Ly Hon Avenue, Pittsburgh, PA 15213, USA
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  • Ami Patel
    Affiliations
    Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA
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  • Daniel Edmundowicz
    Affiliations
    Divisions of Cardiology, University of Pittsburgh, 120 Ly Hon Avenue, Pittsburgh, PA 15213, USA
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  • Anne Newman
    Affiliations
    Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA

    Divisions of Gerontology, University of Pittsburgh, 3520 Fifth Avenue, Pittsburgh, PA 15213, USA
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      Abstract

      The Healthy Women Study has evaluated risk factor changes as women go through the menopause. In 274 women, measures of atherosclerosis in the coronary, aorta and carotid arteries were obtained at 8 years postmenopause using electron beam tomography and carotid ultrasound. The purpose of this study was to evaluate the association between baseline premenopausal risk factors and subclinical disease in various vascular beds and with an aggregate atherosclerosis index based on all subclinical measures. The prevalence of measurable disease for the coronaries, carotids and aorta was 45, 55 and 72%, respectively. Disease measures across these three locations were significantly correlated (P<0.001). Premenopausal LDL, triglycerides, blood pressure (BP) and smoking were associated with each measure of subclinical atherosclerosis, and were strikingly associated with the number of elevated disease measures. Among 126 women taking hormone replacement therapy (HRT), there was a strong positive association between systolic BP and subclinical atherosclerosis (P<0.001). No such relationship was seen among women not on HRT and this interaction was significant (P=0.048). An index of subclinical atherosclerosis rather than measurement at a single arterial site may be the best estimate of disease risk. Such a measure should be evaluated for its prognostic value along with individual measures of subclinical disease. Women with lower premenopausal risk factors did not develop high levels of subclinical atherosclerosis, suggesting that atherosclerosis is a preventable disease in women.

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      References

      1. Eaker E.D. Packard B. Wenger N.K. Clarkson T.B. Tyroler H.A. Coronary heart disease in women. Haymarket Doyma, New York1987
        • Kannel W.B.
        • Wilson P.W.F.
        Risk factors that attenuate the female coronary disease advantage.
        Arch Intern Med. 1995; 155: 57-61
        • Lasilla H.C.
        • Sutton-Tyrrell K.
        • Matthews K.A.
        • Wolfson S.K.
        • Kuller L.H.
        Prevalence and determinants of carotid atherosclerosis in health postmenopausal women.
        Stroke. 1997; 28: 513-517
        • Sutton-Tyrrell K.
        • Lasilla H.C.
        • Meilahn E.
        • Bunker C.
        • Matthews K.A.
        • Kuller L.H.
        Carotid atherosclerosis in premenopausal and postmenopausal women and its association with risk factors measured at premenopause.
        Stroke. 1998; 29: 1116-1121
        • Probstfield J.L.
        • Byington R.P.
        • Egan D.A.
        • Espeland M.A.
        • Margitic S.E.
        • Riley W.A.
        • et al.
        Methodological issues facing studies of atherosclerotic change.
        Circulation. 1993; 87: II-74-II-81
        • Furberg C.D.
        • Adams H.P.
        • Applegate W.B.
        • Byington R.P.
        • Espeland M.A.
        • Hartwell T.
        • et al.
        Asymptomatic Carotid Artery Progression Study (ACAPS) Research Group.
        Circulation. 1994; 90: 1679-1687
        • Crouse J.R.
        • Byington R.P.
        • Bond M.G.
        • Espeland M.A.
        • Craven T.E.
        • Sprinkle J.W.
        • et al.
        Pravastatin, lipids, and atherosclerosis in the carotid arteries (PLAC-II).
        Am J Cardiol. 1995; 75: 455-459
        • Blankenhorn D.H.
        • Robert Selzer R.H.
        • Crawford D.W.
        • Barth J.D.
        • Liu C.
        • Mack W.J.
        • et al.
        Beneficial effects of colestipol–niacin therapy on the common carotid artery. Two- and four-year reduction of intima-media thickness measured by ultrasound.
        Circulation. 1993; 88: 20-28
        • Craven T.E.
        • Ryu J.E.
        • Espeland M.A.
        • Kahl F.R.
        • McKiney W.M.
        • Toole J.F.
        • et al.
        Evaluation of the associations between the coronary and cerebral vascular beds.
        Circulation. 1990; 82: 1230-1242
        • Young W.
        • Gofman J.W.
        • Tandy R.
        • Malamud N.
        • Waters E.S.
        The quantitation of atherosclerosis: III. The extent of correlation of degrees of atherosclerosis within and between the coronary and cerebral vascular beds.
        Am J Cardiol. 1960; 6: 300-308
        • Rumberger J.A.
        • Simons D.B.
        • Fitzpatrick L.A.
        • Sheedy P.F.
        • Schwartz R.S.
        Coronary artery calcium areas by electron beam computed tomography and coronary atherosclerosis plaque area: a histopathologic correlative study.
        Circulation. 1995; 92: 2157-2162
        • Detrano R.C.
        • Wong N.D.
        • Doherty T.M.
        • Shavelle R.
        Prognostic significance of coronary calcific deposits in asymptomatic high-risk subjects.
        Am J Med. 1997; 102: 344-349
        • Arad Y.
        • Spadaro L.A.
        • Goodman K.
        • Lledo-Perez A.
        • Sherman S.
        • Lerner G.
        • et al.
        Predictive value of electron beam computed tomography of the coronary arteries. 19-month follow-up of 1173 asymptomatic subjects.
        Circulation. 1996; 93: 1951-1953
        • Agatston A.S.
        • Janowitz W.R.
        • Kaplan G.S.
        • Lee D.
        • Prashad R.
        • Viamonte Jr, M.
        Electron beam CT coronary calcium predicts future coronary events [abstract].
        Circulation. 1996; 94: I360
        • Matthews K.
        • Kelsey S.
        • Meilahn E.
        • Kuller L.
        • Wing R.
        Educational attainment and behavioral and biologic risk factors for coronary heart disease in middle-aged women.
        Am J Epidemiol. 1989; 129: 1132-1144
        • Kuller L.H.
        • Meilahn E.N.
        • Gutai J.
        • Cauley J.
        • Wing R.R.
        • Matthews K.A.
        • et al.
        Lipoproteins, estrogens and the menopause. (Chapter 16).
        in: Korenman S.G. The menopause – biological and clinical consequences of ovarian failure: evolution and management. Norwell, MS. Serono Symposia, USA1990: 179-197
        • Allain C.C.
        • Poon L.S.
        • Chan C.S.
        • Richmond W.
        • Fu P.C.
        Enzymatic determination of total serum cholesterol.
        Clin Chem. 1974; 20: 470-475
        • Warnick G.R.
        • Albers J.J.
        A comprehensive evaluation of the heparin-manganese precipitation procedure for estimating high density lipoprotein cholesterol.
        J Lipid Res. 1978; 19: 65-76
        • Bucolo G.
        • David H.
        Quantitative determination of serum triglycerides by the use of enzymes.
        Clin Chem. 1978; 19: 476-482
        • Friedewald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.
        Clin Chem. 1972; 18: 499-502
        • Stein M.W.
        Determination with hexokinase and glucose-6-phosphate dehydrogenase.
        in: Bergmeyer H.U. Methods of enzymatic analysis. Academic Press, New York1963: 117
        • Sutton-Tyrrell K.
        • Wolfson Jr, S.K.
        • Thompson T.
        • Kelsey S.F.
        Measurement variability in duplex scan assessment of carotid atherosclerosis.
        Stroke. 1992; 23: 215-220
        • Agatston A.S.
        • Janowitz W.R.
        • Hildner F.J.
        • Zuamer N.R.
        • Viamonte Jr, M.
        • Detrano R.
        Quantification of coronary artery calcium using ultrafast computed tomography.
        J Am Coll Cardiol. 1990; 15: 827-832
        • Jonckheere A.R.
        A distribution-free k-sample test against ordered alternatives.
        Biometrika. 1954; 41: 133-145
        • Tejada C.
        • Strong J.P.
        • Montenegro M.R.
        • Restrepo C.
        • Colberg L.A.
        Distribution of coronary and aortic atherosclerosis by geographic location, race and sex.
        Lab Investigat. 1968; 18: 509-526
        • Strong J.P.
        • Malcom G.T.
        • McMahan C.A.
        • Tracy R.E.
        • Newman W.P.
        • Herderick E.E.
        • et al.
        Pathobilogical determinants of atherosclerosis in youth research group. Prevalence and extent of atherosclerosis in adolescents and young adults. Implications for prevention from the pathobiological determinants of atherosclerosis in youth study.
        JAMA. 1999; 281: 727-735
        • Witteman J.C.M.
        • Kannel W.B.
        • Wolf P.A.
        • Grobbee D.E.
        • Hofman A.
        • D'Agostino R.B.
        • et al.
        Aortic calcified plaques and cardiovascular disease (The Framingham Study).
        Am J Cardiol. 1990; 66: 1060-1064
        • Criqui M.H.
        • Langer R.D.
        • Fronek A.
        • Feigelson H.S.
        • Klauber M.R.
        • McCann T.J.
        • et al.
        Mortality over a period of 10 years in patients with peripheral arterial disease.
        N Engl J Med. 1992; 326: 381-386
        • Newman A.B.
        • Sutton-Tyrrell K.
        • Kuller L.H.
        Mortality over four years in SHEP participants with a low ankle–arm index.
        J Am Geriatr Soc. 1997; 45: 1472-1478
        • Newman A.B.
        • Shemanski L.
        • Manolio T.A.
        • Cushman M.
        • Mittelmark M.
        • Polak J.F.
        • et al.
        Cardiovascular Health Study Collaborative Research Group.
        Arterioscler Thromb Vasc Biol. 1999; 19: 538-545
        • Chambless L.E.
        • Heiss G.
        • Folsom A.R.
        • Rosamond W.
        • Szklo M.
        • Sharrett A.R.
        • et al.
        Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the atherosclerosis risk in communities (ARIC) study, 1987–1993.
        Am J Epidemiol. 1997; 146: 483-494
        • O'Leary D.H.
        • Polak J.F.
        • Kronmal R.A.
        • Manolio T.A.
        • Burke G.L.
        • Wolfson S.K.
        Cardiovascular Health Study Collaborative Research Group. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults.
        N Engl J Med. 1999; 340: 14-22
        • Kuller L.H.
        • Shemanski L.
        • Psaty B.M.
        • Borhani N.O.
        • Gardin J.
        • Haan M.N.
        • et al.
        Subclinical disease as an independent risk factor for cardiovascular disease.
        Circulation. 1995; 92: 720-726
        • Petitti D.B.
        Hormone replacement therapy and heart disease prevention-experimentation trumps observation.
        JAMA. 1998; 280: 650-652
        • Nabulsi A.A.
        • Folsom A.R.
        • Szklo M.
        • White A.
        • Higgins M.
        • Heiss G.
        No association of menopause and hormone replacement therapy with carotid artery intima-media thickness.
        Circulation. 1996; 94: 1857-1863
        • Sarrel P.M.
        How progestins compromise the cardioprotective effects of estrogens.
        Menopause. 1995; 2: 187-190
        • Sarrel P.M.
        Cardiovascular disease in women: implications of hormone replacement therapy.
        Int J Fertility Menopausal Studies. 1996; 41: 90-93
        • Prineas R.J.
        • Harland W.R.
        • Janzon L.
        • Kannel W.
        Recommendations for use of noninvasive methods to detect atherosclerotic peripheral disease in population studies. American Heart Association Council on Cardiovascular Disease Epidemiology.
        Circulation. 1982; 65: 1561A-1566A
        • Zheng Z.J.
        • Sharrett A.R.
        • Chambless L.E.
        • et al.
        Associations of ankle-brachial index with clinical coronary heart disease, stroke and preclinical carotid and popliteal atherosclerosis: the ARIC Study.
        Atherosclerosis. 1997; 131: 115-125