Serial Studies in Subclinical Atherosclerosis During Menopausal Transition (from the Study of Women's Health Across the Nation)

Zubair A. Khan, Imke Janssen, Joanne K. Mazzarelli, Lynda H. Powell, Andrius Dumasius, Susan Everson-Rose, Emma Barinas-Mitchell, Karen Matthews, Samar R. El Khoudary, Perry J. Weinstock, Steven M. Hollenberg

Research output: Contribution to journalArticle

Abstract

Cardiovascular disease risk increases in women after the menopausal transition; why this inflection point occurs remains uncertain. We aimed to characterize the influence of menopause on vascular aging by prospective assessment of change in indexes of subclinical atherosclerosis across the menopausal transition. We evaluated 411 healthy women from SWAN Heart, an ancillary study of SWAN (Study of Women's Health Across the Nation), for subclinical atherosclerosis at baseline and again after an average of 2.3 years. Carotid intima-media thickness and aortic pulse wave velocity were measured by ultrasound. Coronary artery calcium scores were obtained by computed tomography. Women were grouped by menopausal status as premenopausal, postmenopausal, or having undergone the transition during follow-up. Analyses of changes were adjusted for age at baseline and time between scans. Mean age at baseline was 51 ± 3 years; 93 (23%) subjects transitioned to menopause (Pre-Post), 147 (36%) remained premenopausal (Pre-Pre), while 171 (41%) were postmenopausal at baseline (Post-Post). Blood pressure readings did not differ between groups with similar increase noted in carotid intima-media thickness and log coronary artery calcium + 1 from baseline to follow-up. Change in aortic pulse wave velocity from baseline to follow-up was higher in Pre-Post (121 ± 23 cm/s) compared with Pre-Pre (38 ± 250 cm/s, p = 0.029) and Post-Post (41 ± 228 cm/s, p = 0.045). In conclusion, changes in aortic stiffness were more sensitive measures of perimenopausal vascular aging than morphologic indexes of subclinical atherosclerosis in women undergoing the menopausal transition. Serial assessment of such changes could potentially elucidate mechanisms of disease and identify women to target for aggressive lifestyle risk factor modification.

Original languageEnglish (US)
Pages (from-to)1161-1168
Number of pages8
JournalAmerican Journal of Cardiology
Volume122
Issue number7
DOIs
StatePublished - Oct 1 2018

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Women's Health
Atherosclerosis
Menopause
Carotid Intima-Media Thickness
Pulse Wave Analysis
Blood Vessels
Coronary Vessels
Calcium
Vascular Stiffness
Life Style
Reading
Cardiovascular Diseases
Tomography
Blood Pressure

Cite this

Serial Studies in Subclinical Atherosclerosis During Menopausal Transition (from the Study of Women's Health Across the Nation). / Khan, Zubair A.; Janssen, Imke; Mazzarelli, Joanne K.; Powell, Lynda H.; Dumasius, Andrius; Everson-Rose, Susan; Barinas-Mitchell, Emma; Matthews, Karen; El Khoudary, Samar R.; Weinstock, Perry J.; Hollenberg, Steven M.

In: American Journal of Cardiology, Vol. 122, No. 7, 01.10.2018, p. 1161-1168.

Research output: Contribution to journalArticle

Khan, ZA, Janssen, I, Mazzarelli, JK, Powell, LH, Dumasius, A, Everson-Rose, S, Barinas-Mitchell, E, Matthews, K, El Khoudary, SR, Weinstock, PJ & Hollenberg, SM 2018, 'Serial Studies in Subclinical Atherosclerosis During Menopausal Transition (from the Study of Women's Health Across the Nation)', American Journal of Cardiology, vol. 122, no. 7, pp. 1161-1168. https://doi.org/10.1016/j.amjcard.2018.06.039
Khan, Zubair A. ; Janssen, Imke ; Mazzarelli, Joanne K. ; Powell, Lynda H. ; Dumasius, Andrius ; Everson-Rose, Susan ; Barinas-Mitchell, Emma ; Matthews, Karen ; El Khoudary, Samar R. ; Weinstock, Perry J. ; Hollenberg, Steven M. / Serial Studies in Subclinical Atherosclerosis During Menopausal Transition (from the Study of Women's Health Across the Nation). In: American Journal of Cardiology. 2018 ; Vol. 122, No. 7. pp. 1161-1168.
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AU - Powell, Lynda H.

AU - Dumasius, Andrius

AU - Everson-Rose, Susan

AU - Barinas-Mitchell, Emma

AU - Matthews, Karen

AU - El Khoudary, Samar R.

AU - Weinstock, Perry J.

AU - Hollenberg, Steven M.

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AB - Cardiovascular disease risk increases in women after the menopausal transition; why this inflection point occurs remains uncertain. We aimed to characterize the influence of menopause on vascular aging by prospective assessment of change in indexes of subclinical atherosclerosis across the menopausal transition. We evaluated 411 healthy women from SWAN Heart, an ancillary study of SWAN (Study of Women's Health Across the Nation), for subclinical atherosclerosis at baseline and again after an average of 2.3 years. Carotid intima-media thickness and aortic pulse wave velocity were measured by ultrasound. Coronary artery calcium scores were obtained by computed tomography. Women were grouped by menopausal status as premenopausal, postmenopausal, or having undergone the transition during follow-up. Analyses of changes were adjusted for age at baseline and time between scans. Mean age at baseline was 51 ± 3 years; 93 (23%) subjects transitioned to menopause (Pre-Post), 147 (36%) remained premenopausal (Pre-Pre), while 171 (41%) were postmenopausal at baseline (Post-Post). Blood pressure readings did not differ between groups with similar increase noted in carotid intima-media thickness and log coronary artery calcium + 1 from baseline to follow-up. Change in aortic pulse wave velocity from baseline to follow-up was higher in Pre-Post (121 ± 23 cm/s) compared with Pre-Pre (38 ± 250 cm/s, p = 0.029) and Post-Post (41 ± 228 cm/s, p = 0.045). In conclusion, changes in aortic stiffness were more sensitive measures of perimenopausal vascular aging than morphologic indexes of subclinical atherosclerosis in women undergoing the menopausal transition. Serial assessment of such changes could potentially elucidate mechanisms of disease and identify women to target for aggressive lifestyle risk factor modification.

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