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. 2023 Dec 1;30(12):1190-1198.
doi: 10.1097/GME.0000000000002273. Epub 2023 Nov 7.

Carotid intima media thickness and cardiometabolic dysfunction: the Study of Women's Health Across the Nation

Aleda M Leis  1 , Elizabeth A Jackson  2 , Ana Baylin, Emma Barinas-Mitchell  3 , Samar R El Khoudary  3 , Carrie A Karvonen-Gutierrez  1
Affiliations

Carotid intima media thickness and cardiometabolic dysfunction: the Study of Women's Health Across the Nation

Aleda M Leis et al. Menopause. .

Abstract

Objective: Carotid artery intima media thickness (cIMT) and adventitial diameter (AD) are subclinical atherosclerosis indicators. Metabolic syndrome (MetS) and obesity are risk factors for atherosclerosis, but their combined impact on atherosclerosis risk is unknown. This study sought to examine the effect of the co-occurrence of MetS with obesity on cIMT and AD.

Methods: The Study of Women's Health Across the Nation (SWAN) is a multi-center, multi-ethnic study. Carotid ultrasound assessments and concurrent physiologic measurements were undertaken between 2009 and 2013. This cross-sectional analysis included 1,433 women with body mass index ≥18.5 kg/m 2 and free of prevalent clinical cardiovascular disease. Multivariable linear regression models were used to relate maximum cIMT and AD (dependent variables) with obesity, MetS and their interaction.

Results: The average age was 60.1 years (standard deviation [SD], 2.7 y). The prevalence of obesity and MetS was 44% and 35%, respectively. Women with obesity had a 0.051 mm larger mean cIMT and women with MetS had a 0.057 mm larger cIMT versus women without the respective conditions (both P < 0.001). There was a statistically significant interaction between obesity and MetS ( P = 0.011); women with both had a model-adjusted predicted mean cIMT of 0.955 mm (95% confidence interval [CI], 0.897-1.013), higher than those with MetS alone (0.946 mm; 95% CI, 0.887-1.005), obesity alone (0.930 mm; 95% CI, 0.873-0.988), or neither condition (0.878 mm; 95% CI, 0.821-0.935). AD results were similar.

Conclusions: Early detection and treatment of atherosclerotic changes may prevent significant disease. This study suggests there is a minimal impact of obesity on carotid artery thickness beyond MetS alone. All individuals with metabolic dysfunction, regardless of obesity status, should be considered at increased risk for atherosclerotic changes.

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Conflict of interest statement

Financial disclosure/conflicts of interest: E.A.J. receives ongoing institutional funding from the National Institute of Health, Agency for Healthcare Research and Quality, and the VA health system. E.A.J. is a member of the American Heart Association editorial board, a consultant for American College of Cardiology and Optum Health, an expert witness for DeBlase, Brown, and Eyerly LLP, and received past institutional funding from Amgen Research. C.A.K.-G. received payment from the University of Jyväskylä Finland for services as expert reviewer of a dissertation. The other authors have nothing to disclose.

Figures

Figure 1.
Figure 1.. Study participant flow diagram.
A visual description of the exclusion criteria for our study.
Figure 2.
Figure 2.. Adjusted multivariable linear regression model results.
Model-predicted mean and 95 percent confidence intervals for (A) maximum carotid intima media thickness and (B) adventitial diameter, after adjustment for age, menopausal status, hormonal therapy use, smoking status, family history of heart disease, and anti-lipemic medication use. Abbreviation: cIMT - carotid intima media thickness, MetS – metabolic syndrome
See this image and copyright information in PMC

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