Prevalence and determinants of carotid atherosclerosis in healthy postmenopausal women

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. 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). 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. 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.