Sutton-Tyrrell K, Lassila H C, Meilahn E, Bunker C, Matthews K A, Kuller L H
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15261, USA.
Stroke. 1998 Jun;29(6):1116-21. doi: 10.1161/01.str.29.6.1116.
In women, symptoms of coronary artery disease are delayed by 10 to 15 years in comparison with men, most likely because of the protective effect of ovarian hormones. This report compares the prevalence and degree of carotid atherosclerosis between 292 premenopausal women and 294 women at 5 to 8 years after menopause.
Scans were performed in the same laboratory over the same time period for both groups. Intima-media thickness (IMT) was averaged across the common, bulb, and internal carotids. The plaque index summarized degree of focal plaque based on the size and number of plaques throughout both carotid systems.
Mean IMT was 0.69 mm for premenopausal women and 0.77 mm for postmenopausal women (P < 0.001). Prevalence of plaque was 25% among premenopausal women and 54% among postmenopausal women (P < 0.001). In both premenopausal and postmenopausal women, risk factors measured before menopause were associated with carotid atherosclerosis. Premenopausal risk factors independently associated with IMT were higher pulse pressure (P < 0.001), triglycerides (P = 0.002), body mass index (P < 0.001), and study group (a surrogate for both age and menopausal status; P < 0.001). Premenopausal risk factors independently associated with focal plaque were ever smoking (P = 0.002), higher pulse pressure (P = 0.028), higher LDL (P = 0.003), age at baseline (P = 0.050), and study group (P < 0.001).
Subclinical carotid atherosclerosis can be observed in middle-aged women. Risk factors measured before menopause are clearly associated with subclinical disease measured both concurrently and at 5 to 8 years after menopause.
与男性相比，女性冠状动脉疾病症状的出现会延迟10至15年，这很可能是由于卵巢激素的保护作用。本报告比较了292名绝经前女性和294名绝经后5至8年女性的颈动脉粥样硬化患病率及程度。
两组均在同一时间段于同一实验室进行扫描。内膜中层厚度（IMT）取颈总动脉、颈动脉球部和颈内动脉的平均值。斑块指数根据双侧颈动脉系统内斑块的大小和数量总结局灶性斑块的程度。
绝经前女性的平均IMT为0.69毫米，绝经后女性为0.77毫米（P<0.001）。绝经前女性的斑块患病率为25%，绝经后女性为54%（P<0.001）。在绝经前和绝经后女性中，绝经前测量的危险因素均与颈动脉粥样硬化相关。与IMT独立相关的绝经前危险因素包括较高的脉压（P<0.001）、甘油三酯（P = 0.002）、体重指数（P<0.001）以及研究组（年龄和绝经状态的替代指标；P<0.001）。与局灶性斑块独立相关的绝经前危险因素包括曾经吸烟（P = 0.002）、较高的脉压（P = 0.028）、较高的低密度脂蛋白（P = 0.003）、基线年龄（P = 0.050）以及研究组（P<0.001）。
中年女性可观察到亚临床颈动脉粥样硬化。绝经前测量的危险因素与绝经时及绝经后5至8年测量的亚临床疾病明显相关。
