Subclinical cardiovascular disease in postmenopausal women with low/medium cardiovascular risk by the Framingham risk score.

Objectives: To evaluate the prevalence of subclinical cardiovascular disease (CVD) and its association with clinical and hormone variables in postmenopausal women from Southern Brazil.

Study Design: Cross-sectional study.

Main Outcome Measures: Coronary artery calcification (CAC) assessed by electron-beam computed tomography. Carotid intima-media thickness (IMT) and atheromatous plaques assessed using B-mode ultrasound. IMT was measured at three segments. Subclinical CVD was defined as the presence of plaque and/or IMT >0.9 mm.

Results: Ninety-seven postmenopausal women (mean age 55 ± 5 years, median duration of menopause 5.8 [3-10] years) were studied. A low/medium Framingham risk score (FRS) was present in 97.9% of participants; 35.1% had subclinical CVD on carotid ultrasound, and 24.7% had the presence of plaque. Seven women had a CAC score ≥ 100, and two had a score ≥ 200. CAC score (p<0.001) and FRS (p=0.013) were higher in patients with subclinical atherosclerosis. Positive correlations were found between IMT and age (rs=0.293 p=0.004), duration of menopause (rs=0.237, p=0.020), and CAC score (rs=0.468, p<0.001). Common carotid IMT (IMT-CC) was negatively associated with estradiol levels (β=-0.237, p=0.018) and positively with age (β=0.210, p=0.033), and BMI (β=0.260, p=0.010). However, correlations with estradiol and age did not remain significant when adjusted for systolic blood pressure and LDL-cholesterol levels.

Conclusion: A high prevalence of subclinical atherosclerosis was detected in this sample of postmenopausal women with low/medium CV risk by the FRS. The association between IMT-CC and age or endogenous estrogen levels was dependent of blood pressure and LDL-cholesterol in these postmenopausal women from Southern Brazil.