Stress-induced pulse pressure change predicts women's carotid atherosclerosis.

BACKGROUND AND PURPOSE: Individuals who exhibit large increases in blood pressure and heart rate during mental stress may be at risk for accelerated atherosclerosis. This report evaluates the association between stress-induced hemodynamic responses and carotid atherosclerosis in 254 healthy postmenopausal women. METHODS: The magnitude of change in blood pressure and heart rate from rest to public speaking and mirror image tracing, two stressful tasks, was measured. Average intima-media thickness (IMT) and focal plaque in the common carotid artery, bulb, and internal carotid artery were measured with the use of duplex ultrasonography on average 2.3 years later. RESULTS: The average IMT was 0.77 mm, with a range of 0.60 to 1.37; 52.5% had at least one plaque. Correlational analysis showed that greater IMT was associated with greater pulse pressure change during mental stress (r = 0.17, P < 0.01). Statistical adjustments for possible confounders (age, hormone replacement therapy use, resting pulse pressure, smoking status, and triglyceride levels) did not alter the results. The plaque index was associated with greater pulse pressure change during the mirror image tracing task (odds ratio = 1.47, P = 0.01) for women with a plaque score of > or = 2 versus 1 or 0, adjusted for possible confounders. CONCLUSIONS: Mental stress-induced pulse pressure changes may influence the development of early atherosclerosis in the carotid artery of women. Widening of pulse pressure during stress, as well as at rest, may be a marker of compromised compliance in the vessel wall.

Carotid atherosclerosis in premenopausal and postmenopausal women and its association with risk factors measured after menopause.

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.

Subclinical atherosclerosis in relation to hysterectomy status in black women.

BACKGROUND AND PURPOSE: This study was designed to investigate whether black women who underwent hysterectomy only (n = 59) or hysterectomy plus bilateral oophorectomy (n=25) were at increased risk of subclinical carotid atherosclerosis compared with black women who underwent natural menopause (n = 54). The effects of both surgery and menopausal status were evaluated. METHODS: Women aged 34 to 58 years were recruited from the Pittsburgh, Pa, area. Postmenopausal status was defined as a serum follicle-stimulating hormone level of >30 mIU/mL. Carotid duplex scans were performed to assess the degree of focal plaque. RESULTS: Among premenopausal women, focal plaque was present in 20% of nonhysterectomized versus 49% of hysterectomized-only women (P=.004). Among postmenopausal women, plaque was present in 69% of nonhysterectomized women, 86% of women with hysterectomy only, and 48% of women with oophorectomy and hysterectomy (P=.056). Among postmenopausal women, hormone replacement therapy was used by 23% of women who had undergone natural menopause, 0% of women with hysterectomy only, and 36% of women with oophorectomy and hysterectomy. The prevalence of plaque was 33% among hormone replacement therapy users versus 73% among nonusers (P=.014). In multivariate analysis, independent associations with the presence of at least 1 plaque were postmenopausal status and hysterectomy only. CONCLUSIONS: These data suggest that black women who undergo hysterectomy without oophorectomy may be at higher risk of subclinical carotid atherosclerosis than black women who undergo natural menopause or hysterectomy plus oophorectomy.

Prevalence and determinants of carotid atherosclerosis in healthy postmenopausal women.

BACKGROUND AND PURPOSE: Subclinical atherosclerosis in the carotid arteries can be assessed noninvasively with B-mode ultrasound. Few studies have included enough younger postmenopausal women to examine risk factors specific to this group that were related to subclinical carotid atherosclerosis. METHODS: A subgroup of 200 participants of the Healthy Women Study underwent B-mode ultrasound of the carotid arteries. Intima-media thickness (IMT) and focal plaque were assessed in each carotid artery. Data regarding risk factors, including blood pressure parameters, lipid values, body mass index, smoking history, and hormone status, were collected at three separate time points (before menopause, 1 year after menopause, and 5 or 8 years after menopause). RESULTS: The mean IMT was 0.76+/-0.11 mm, and 50% of the population had at least one focal plaque. Smoking had the strongest association with the presence of plaque. Women who smoked at the time of the ultrasound evaluation had five times the odds of having at least one focal plaque compared with women who had never smoked (95% confidence interval, 2.0 to 13.0; P < .01). After we controlled for age and years after menopause, premenopausal values of pulse pressure (P < or = .05), LDL cholesterol (P < or = .05), and a history of smoking (P < or = .01) were independently predictive of plaque. Premenopausal values of triglycerides, pulse pressure, and ever smoking were independently related to average IMT after we controlled for age and years after menopause. CONCLUSIONS: This study has provided valuable information about the prevalence of carotid atherosclerosis and the risk factors related to carotid atherosclerosis in a group of healthy postmenopausal women.

Use of prescription medications in an elderly rural population: the MoVIES Project.

OBJECTIVE: To determine the pharmacoepidemiology of prescription drug use in a rural elderly community sample, specifically the numbers and categories of medications taken and the factors associated with them. DESIGN: Cross-sectional community survey. SETTING: The mid-Monongahela Valley of southwestern Pennsylvania. PARTICIPANTS: An age-stratified random sample of 1360 community-dwelling individuals, aged 65 years and older. MEASURES: Self-reported use of prescription drugs demographic characteristics, and use of health services. RESULTS: Nine hundred sixty-seven participants (71%) reported regularly taking at least one prescription medication and 157 (10%) reported taking five or more medications (median 2.0, range 0-13). Women took significantly more medications than men (median 2.0, range 0-13 and median 1.0, range 0-9, respectively; p = 0.01). The use of a greater number of medications was independently and statistically significantly associated with older age, hospitalization within the previous 6 months, home health care in previous year, visit to a physician within the previous year, and insurance coverage for prescription medication. Individuals older than 85 years were significantly more likely to be taking cardiovascular agents, anticoagulants, vasodilating agents, diuretics, and potassium supplements. Significantly more women than men were taking nonsteroidal antiinflammatory drugs, antidepressants, potassium supplements, and thyroid replacement medications. CONCLUSIONS: Both the number and the types of prescription medications vary with age and gender. The demographic and health service use variables associated with greater medication use in the community may help define high-risk groups for polypharmacy and adverse drug reactions. Longitudinal studies are needed.