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Evaluation of clinical and inflammatory markers of subclinical carotid atherosclerosis in postmenopausal women

Nahas, Eliana Aguiar Petri MD, PhD1; Nahas-Neto, Jorge MD, PhD1; Orsatti, Claudio Lera MSc1; Sobreira, Marcone Lima MD, PhD2; Tardivo, Ana Paula MSc1; Witkin, Steven Sol PhD3

doi: 10.1097/GME.0000000000000199
Original Articles

Objective This study aims to evaluate clinical and inflammatory markers of subclinical carotid atherosclerosis (ATS) in asymptomatic postmenopausal women.

Methods This cross-sectional study included 268 Brazilian women (aged ≥45 y and amenorrhea ≥12 mo). Subclinical ATS was defined as increased carotid intima-media thickness (>1.0 mm) and/or the presence of plaques evaluated by carotid duplex ultrasound. Inflammatory markers included C-reactive protein (CRP), as well as heat shock protein (HSP) 60 and HSP70 and their antibodies. Pearson’s correlation and stepwise logistic regression were used for statistical analysis.

Results Among the women studied, 45.9% (123 of 268) had a diagnosis of ATS, and 54.1% (145 of 268) had normal carotid ultrasound scans (controls). Women with ATS were older (56.6 vs 52.5 y), and their time since menopause was longer (6.0 vs 4.0 y). In addition, higher prevalences of metabolic syndrome (39.0% vs 25.5%), hypertension (52.0% vs 30.3%), and diabetes (11.4% vs 4.8%), and elevated circulating levels of CRP and HSP60, were observed in women with ATS compared with controls (P < 0.05). Intima-media thickness was positively correlated with anti-HSP70 antibodies (r = 0.110, P = 0.049) and CRP (r = 0.167, P = 0.009). ATS risk increased with age at menopause (odds ratio [OR], 1.18; 95% CI, 1.10-1.26), time since menopause (OR, 1.12; 95% CI, 1.02-1.14), and glucose of 100 mg/dL or higher (OR, 2.17; 95% CI, 1.12-4.20). Serum HSP70 levels (OR, 0.71; 95% CI, 0.47-0.98) were associated with a lower ATS risk (P < 0.05).

Conclusions In postmenopausal women, age, menopause status, and hyperglycemia are associated with a higher prevalence of ATS, whereas elevated serum HSP70 is associated with a lower prevalence of ATS.

From the Departments of 1Gynecology and Obstetrics and 2Surgery, Botucatu Medical School, Sao Paulo State University, São Paulo, Brazil; and 3Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY.

Received October 4, 2013; revised and accepted December 4, 2013.

Funding/support: This study was supported by the São Paulo Research Foundation (grant 2009/14884-2).

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Eliana Aguiar Petri Nahas, MD, PhD, Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Distrito de Rubião Júnior s/n, Botucatu, SP 18618-970, Brazil. E-mail:

© 2014 by The North American Menopause Society.