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Racial differences in the association between carotid plaque and aortic and coronary artery calcification among women transitioning through menopause

Woodard, Genevieve A. MD, PhD1; Narla, Vinod V. MD2; Ye, Rong MS3; Cauley, Jane A. DrPH1; Thompson, Trina DrPH1; Matthews, Karen A. PhD1; Sutton-Tyrrell, Kim DrPH1

doi: 10.1097/gme.0b013e318227304b
Original Articles

Objective Carotid atherosclerosis is a marker for atherosclerotic disease in other vascular beds; however, racial differences in this association have not been fully examined. The purpose of this report was to evaluate racial differences in the relationship between carotid plaque and calcification in the aorta and coronary arteries among women transitioning through menopause.

Methods A total of 540 African American and white women with a median age of 50 years were evaluated from the Study of Women’s Health Across the Nation. Carotid plaque (none vs. any) was assessed with B-mode ultrasound, and aortic calcification (AC; 0, >0-100, and >100) and coronary artery calcification (CAC; 0, >0-10, and >10) were assessed with CT.

Results For the total cohort, higher prevalence of plaque was significantly associated with higher levels of AC but not CAC. The interaction of race and carotid plaque was significant in models with AC and CAC as dependent variables (P = 0.03 and 0.002, respectively). Among African Americans, there was an inverse relationship, although not significant, between carotid plaque and high AC (>100; odds ratio [OR], 0.75; 95% CI, 0.10-5.48) and between plaque and high CAC (>10; OR, 0.20; 95% CI, 0.03-1.52) in fully adjusted models. In contrast, for whites, significant positive associations existed between carotid plaque and high AC (OR, 4.12; 95% CI, 1.29-13.13) and borderline associations for high CAC (OR, 1.83; 95% CI, 0.66-5.19).

Conclusions This study demonstrates that the presence of carotid plaque seemed to be a marker for AC and potentially CAC in white women, but not African American middle-aged women, during the menopausal transition.

The association between carotid plaque and calcification in the aorta and coronary arteries differs by race among women transitioning through menopause.

From the 1Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA; 2Department of Radiology, University of Washington, Seattle, WA; and 3University of Texas School of Public Health, Houston, TX.

Received April 4, 2011; revised and accepted May 31, 2011.

Funding/support: The Study of Women’s Health Across the Nation (SWAN) has received grant support from the National Institutes of Health (NIH), Department of Health and Human Services, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the NIH Office of Research on Women’s Health (ORWH; grants NR004061; AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, AG012495). SWAN Heart was supported by grants from the NIH through the National Heart, Lung, and Blood Institute (HL065581, HL065591).

The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH, or NIH.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Genevieve A. Woodard, MD, PhD, 6303 Morrowfield Ave, Pittsburgh, PA 15217. E-mail:

©2012The North American Menopause Society