Subclinical Atherosclerosis Across the Menopausal Transition in Women With and Without HIV

Abstract

The menopausal transition is a pivotal time of cardiovascular risk, but knowledge is limited in HIV. We studied longitudinal carotid artery intima-media thickness (CIMT) in the Women's Interagency HIV Study (2004-2019; 979 women/3247 person-visits; 72% with HIV). Among women with HIV only, those who transitioned had greater age-related CIMT progression compared to those remaining premenopausal (difference in slope = 1.64 µm/year, P = .002); and CIMT increased over time in the pretransition (3.47 µm/year, P = .002) and during the menopausal transition (9.41 µm/year, P < .0001), but not posttransition (2.9 µm/year, P = .19). In women with HIV, menopause may accelerate subclinical atherosclerosis as measured by CIMT.

Keywords: HIV; atherosclerosis; cardiovascular disease; menopause.

Figure 1.

Association of age with longitudinal progression of carotid artery intima-media thickness (CIMT) among women who remained premenopausal, transitioned from pre- to postmenopause, or were postmenopausal. Thin lines represent progression of CIMT within individuals. Thick lines represent estimates from a linear mixed-effect model, with random intercept and terms for menopausal transition status (remained premenopausal, transitioned from pre- to postmenopausal, postmenopausal), age, and the interaction of age and menopausal transition status. Sample sizes (number of women/person-visits): all (979/3247), women with HIV (703/2321), women without HIV (276/926).

Figure 2.

Relationship of years before/after the final menstrual period (FMP) with carotid artery intima-media thickness (CIMT). Estimates are from a linear model (dashed line) or a piece-wise linear mixed-effects model (solid line) with 3 time segments: pretransition (>2 years before FMP), menopausal transition (2 years before to 2 years after FMP), and posttransition (>2 years after FMP). The linear model included a term for years before/after the FMP, while the piece-wise model included terms for years before/after the FMP, and the interaction of the second time segment (>2 years before FMP) and the third time segment (>2 years after FMP) with years before/after FMP. All models included a random intercept per participant and were adjusted for age at FMP, HIV status, study site, race/ethnicity, income, educational attainment, employment, smoking status, alcohol use status, substance use, hepatitis C virus serostatus, hormonal contraceptive use, body mass index, systolic and diastolic blood pressure, diabetes, use of lipid-lowering medications, and use of hypertension medications. Among participants with HIV, model additionally adjusted for HIV viral load, CD4⁺ cell count, and antiretroviral therapy. Sample sizes (number of women/person-visits): all (284/977), women with HIV (209/705), women without HIV (75/272).