Carotid Atherosclerosis in Premenopausal and Postmenopausal Women and Its Association With Risk Factors Measured After Menopause

Sutton-Tyrrell, Kim; Lassila, Holly C.; Meilahn, Elaine N.; Bunker, Clareann H.; Matthews, Karen A.; Kuller, Lewis H.

doi:10.1161/01.str.29.6.1116

Cited by 160 publications

(101 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our findings that traditional risk factors were associated with all 3 measures of subclinical cardiovascular disease are consistent with our previous findings in women with SLE and the findings of other studies in nonlupus populations (36)(37)(38)(39)(40)(41). These factors include older age, high blood pressure, high cholesterol, smoking, and elevated glucose and insulin levels.…”

Section: Discussionsupporting

confidence: 92%

Comparison of risk factors for vascular disease in the carotid artery and aorta in women with systemic lupus erythematosus

Selzer¹,

Sutton-Tyrrell²,

Fitzgerald³

et al. 2004

Arthritis & Rheumatism

Self Cite

193

134

View full text Add to dashboard Cite

Objective. To examine and compare risk factors for various stages of subclinical vascular disease in different vascular beds (carotid and aorta) in women with systemic lupus erythematosus (SLE) who have not yet developed clinical cardiovascular disease.Methods. This cross-sectional study was conducted in 214 women without clinical cardiovascular disease who were enrolled in the Pittsburgh Lupus Registry. B-mode ultrasound was used to measure carotid plaque and intima-media wall thickness (IMT). Doppler probes were used to collect pulse-wave velocity waveforms from the right carotid and femoral arteries as a measure of aortic stiffness. All risk factor data were collected on the day of the ultrasound examinations.Results. The mean ؎ SD age of the women was 45.2 ؎ 10.5 years and the median SLE disease duration was ϳ9 years. Sixty-eight (32%) of the women had at least 1 focal plaque. The mean ؎ SD IMT was 0.71 ؎ 0.1 mm, and the mean ؎ SD pulse-wave velocity was 5.96 ؎ 1.6 meters/second. Using logistic regression, we found that determinants of plaque included older age, higher systolic blood pressure, lower levels of high-density lipoprotein 3, and antidepressant use. Determinants of plaque severity were older age, higher systolic blood pressure, lower levels of albumin, and smoking. Independent determinants of the highest quartile of IMT were older age, higher pulse pressure, lower levels of albumin, elevated C-reactive protein levels, high cholesterol, and higher levels of glucose. Higher aortic stiffness was associated with older age, higher systolic blood pressure, higher C3 levels, lower white blood cell count, higher insulin levels, and renal disease.Conclusion. In women with SLE, the risk factors associated with carotid plaque and IMT are those typically associated with cardiovascular disease in the general population, whereas the risk factors associated with vascular stiffness include SLE-specific variables related to immune dysregulation and complement metabolism. The high prevalence of cardiovascular disease among lupus patients may result from both early adverse effects on vascular stiffening as well as later promotion of wall thickening and plaque through inflammatory-mediated processes. These observations provide clues for future mechanistic studies.Systemic lupus erythematosus (SLE) affects primarily women and causes chronic vascular inflammation. Women with SLE, particularly those under age 45 years, experience higher than expected rates of clinical cardiovascular disease, i.e., hypertension (1-3), myocardial infarction (1,4), and stroke (4). In addition to traditional cardiovascular risk factors, other factors specifically associated with SLE appear to be equally, if not more, important (5,6). It is likely that these factors are related to the underlying immune-mediated, inflammatory processes inherent in SLE.Although the pathogenesis of vascular disease in SLE is unknown, it is thought to be multifactorial and of atherosclerotic origin. Atherosclerosis involves both atherosis (fatty degeneration) an...

show abstract

Section: Discussionsupporting

confidence: 92%

Comparison of risk factors for vascular disease in the carotid artery and aorta in women with systemic lupus erythematosus

Selzer¹,

Sutton-Tyrrell²,

Fitzgerald³

et al. 2004

Arthritis & Rheumatism

Self Cite

193

134

View full text Add to dashboard Cite

show abstract

“…As reported elsewhere in a subsample of the present group, 18 the higher the IMT quartile scores, the greater were the premenopausal levels of systolic blood pressure, pulse pressure, LDL cholesterol, triglycerides, fasting glucose, and body mass index and the lower were the premenopausal levels of HDL cholesterol (Table 4).…”

Section: Risk Factor Change During the Menopause And Carotid Diseasesupporting

confidence: 83%

“…As reported elsewhere in a subsample of the study group, 18 women with elevated plaque or IMT scores had an atherogenic risk factor profile when they were premenopausal, including elevated systolic blood pressure, pulse pressure, LDL cholesterol, triglycerides, and body mass index and low HDL cholesterol.…”

Section: Discussionsupporting

confidence: 70%

Changes in Cardiovascular Risk Factors During the Perimenopause and Postmenopause and Carotid Artery Atherosclerosis in Healthy Women

Matthews

Kuller

Sutton-Tyrrell

et al. 2001

Stroke

Self Cite

193

111

View full text Add to dashboard Cite

Background and Purpose-The objectives of this study were to describe the changes in cardiovascular risk factors during the perimenopausal and early postmenopausal years and correlate those changes in risk factors with carotid intimal-medial thickness (IMT) and plaque index measured 5 to 8 years after menopause. Methods-Participants were women (nϭ372) from Allegheny County, Pennsylvania, enrolled in the Healthy Women Study who had been postmenopausal for at least 5 years. Risk factor changes were measured during the perimenopause, ie, between the premenopausal and first year postmenopausal examinations, and during the early postmenopause, ie, between the first and fifth year postmenopausal examinations. Carotid ultrasound scans measured IMT and plaque at examinations 5 to 8 years after menopause among 314 of the women. Results-Increases in LDL cholesterol and triglycerides and declines in HDL cholesterol were greater during perimenopause than postmenopause, whereas increases in blood pressure and fasting glucose levels were greater during postmenopause. Premenopausal systolic and pulse pressure, LDL and HDL cholesterol, triglycerides, and body mass index predicted IMT and plaque. Only the change in pulse pressure between premenopausal and first year postmenopausal examinations was related to both IMT and plaque. Conclusions-Absolute risk for cardiovascular disease increases substantially in midlife, with a particularly adverse effect on lipid metabolism at the menopause. Premenopausal levels of risk factors are adequate to identify which women should be targeted for intervention.

show abstract

“…This conclusion is supported by a recent study showing the presence of relatively extensive focal atherosclerosis in premenopausal women. 170 Ovarian abnormalities or failure, by reducing the amount of endogenous estrogen, could accelerate atherogenesis in premenopausal women, thereby predisposing these individuals to CAD (and possibly ischemic stroke) in later years.…”

Section: Sex Differencesmentioning

confidence: 99%

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

1999

View full text Add to dashboard Cite

Abstract-Recent studies provide clear and convincing evidence that psychosocial factors contribute significantly to the pathogenesis and expression of coronary artery disease (CAD). This evidence is composed largely of data relating CAD risk to 5 specific psychosocial domains: (1) depression, (2) anxiety, (3) personality factors and character traits, (4) social isolation, and (5) chronic life stress. Pathophysiological mechanisms underlying the relationship between these entities and CAD can be divided into behavioral mechanisms, whereby psychosocial conditions contribute to a higher frequency of adverse health behaviors, such as poor diet and smoking, and direct pathophysiological mechanisms, such as neuroendocrine and platelet activation. An extensive body of evidence from animal models (especially the cynomolgus monkey, Macaca fascicularis) reveals that chronic psychosocial stress can lead, probably via a mechanism involving excessive sympathetic nervous system activation, to exacerbation of coronary artery atherosclerosis as well as to transient endothelial dysfunction and even necrosis. Evidence from monkeys also indicates that psychosocial stress reliably induces ovarian dysfunction, hypercortisolemia, and excessive adrenergic activation in premenopausal females, leading to accelerated atherosclerosis.Also reviewed are data relating CAD to acute stress and individual differences in sympathetic nervous system responsivity. New technologies and research from animal models demonstrate that acute stress triggers myocardial ischemia, promotes arrhythmogenesis, stimulates platelet function, and increases blood viscosity through hemoconcentration. In the presence of underlying atherosclerosis (eg, in CAD patients), acute stress also causes coronary vasoconstriction. Recent data indicate that the foregoing effects result, at least in part, from the endothelial dysfunction and injury induced by acute stress. Hyperresponsivity of the sympathetic nervous system, manifested by exaggerated heart rate and blood pressure responses to psychological stimuli, is an intrinsic characteristic among some individuals. Current data link sympathetic nervous system hyperresponsivity to accelerated development of carotid atherosclerosis in human subjects and to exacerbated coronary and carotid atherosclerosis in monkeys.Thus far, intervention trials designed to reduce psychosocial stress have been limited in size and number. Specific suggestions to improve the assessment of behavioral interventions include more complete delineation of the physiological mechanisms by which such interventions might work; increased use of new, more convenient "alternative" end points for behavioral intervention trials; development of specifically targeted behavioral interventions (based on profiling of patient factors); and evaluation of previously developed models of predicting behavioral change. The importance of maximizing the efficacy of behavioral interventions is underscored by the recognition that psychosocial stresses tend to cluster together. ...

show abstract

Carotid Atherosclerosis in Premenopausal and Postmenopausal Women and Its Association With Risk Factors Measured After Menopause

Cited by 160 publications

References 45 publications

Comparison of risk factors for vascular disease in the carotid artery and aorta in women with systemic lupus erythematosus

Comparison of risk factors for vascular disease in the carotid artery and aorta in women with systemic lupus erythematosus

Changes in Cardiovascular Risk Factors During the Perimenopause and Postmenopause and Carotid Artery Atherosclerosis in Healthy Women

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

Contact Info

Product

Resources

About