Abstract and Introduction
Abstract
Objective: Women of perimenopause age experience an upward transition of cardiovascular risk possibly in association with changing hormonal status. We examined the cross-sectional relationships between the atherosclerotic plaque within the coronary and carotid arteries and aorta and the menopausal hormone levels among asymptomatic perimenopausal women.
Methods: The Assessment of the Transition of Hormonal Evaluation with Noninvasive Imaging of Atherosclerosis was a prospective substudy of the Prospective Army Coronary Calcium project. We screened 126 asymptomatic perimenopausal women (mean age, 50 y) using contrast-enhanced CT angiography (multidetector CT) and carotid ultrasound. Women had coronary calcium data from 5 to 10 years earlier. The measures included cardiovascular risk factors, serum hormone levels, 64-slice multidetector CT, and carotid ultrasound.
Results: The prevalence of any coronary plaque was 35.5%. The prevalence of noncalcified plaque was 30.2%, and noncalcified plaque was the only manifestation of coronary artery disease in 10.7%. Markers of androgenicity (increased free testosterone and reduced sex hormone–binding globulin) were associated with an increased extent of calcified and noncalcified coronary artery plaque and aortic plaque. However, these relationships were not independent of cardiovascular risk factors. Follicle-stimulating hormone was directly associated with the number of aortic plaques. The levels of estrogen hormones were unrelated to plaque presence or extent.
Conclusions: Coronary, aortic, and carotid arterial plaque is prevalent in perimenopausal women without cardiac symptoms. The assessment of perimenopausal hormone status was not independently associated with subclinical atherosclerosis beyond standard cardiovascular risk factors.
Introduction
Women of perimenopause age experience an upward transition of cardiovascular risk, accounting for an approximately 10-year lag in the incidence of coronary heart disease between men and women. Changing hormonal levels are felt to be central in this process, with reductions in estrogen levels and a gradual decrease in testosterone levels, which lead to changes in lipid levels and insulin resistance. The Women's Health Study showed that women who had the highest androgen profiles had a higher prevalence of metabolic syndrome and a twofold higher risk of cardiovascular events.
The relationship between the timing of hormonal changes and the development of increased levels of coronary atherosclerosis may be central to the menopausal transition in cardiovascular risk. Before menopause, calcified coronary atherosclerosis is uncommon in women. However, a majority of atherosclerosis is noncalcified; therefore, calcium detection techniques such as noncontrast cardiac CT may underidentify coronary atherosclerosis. The development of coronary CT angiography as a noninvasive technique for the examination of the coronary arterial wall provides the ability to test for the presence of both calcified and noncalcified atherosclerosis, leading to a more complete assessment of atherosclerosis burden.
We examined the cross-sectional relationships between coronary (calcified and noncalcified), carotid, aortic plaque, and menopausal hormone levels among perimenopausal women with no cardiac history in the Assessment of the Transition of Hormonal Evaluation with Noninvasive Imaging of Atherosclerosis (ATHENA-CT) study. The aims of this study were to define the prevalence, extent, and predictors of atherosclerotic burden as detected by multidetector CT (MDCT) angiography in perimenopausal women and to examine the relationship between reproductive hormone levels and menopause status and the presence and extent of calcified and noncalcified atherosclerosis.