Abstract 5027: Endogenous and Exogenous Reproductive Hormones and Preclinical Atherosclerosis in Women: The Los Angeles Atherosclerosis Study (LAAS)
While the relation between declining estrogen levels and accelerated cardiovascular risk has been extensively documented, little information exists on the relationship of sex steroids and preclinical atherosclerosis in women. We hypothesized that hormone therapy use and changing hormone levels associated with the transition to the menopause would be associated with preclinical atherosclerosis progression.
Methods: We evaluated 240 women undergoing carotid intimal-media thickness (cIMT) measurement in the LAAS study, a prospective cohort study that included women aged 45– 60 years at entry without diagnosed cardiovascular disease who underwent three sequential measurements (baseline, 1.5 and 3 year). cIMT was measured bilaterally in two body positions (lateral and supine), and average thickness over a 1 cm segment of the distal wall 25 mm proximal to the bulb was measured using automated edge-tracking software with a validated protocol reproducibility of a standard deviation of 22 μm for differences between repeated scans by different sonographers. Core laboratory analyses included total and free estradiol and testosterone, as well as estrone, follicle stimulating hormone (FSH), luteinizing hormone (LH), SHBG, androstenedione, DHEA-S, fasting glucose and insulin.
Results: The mean age was 52±4 years, 48% were non-white, and average body mass index was 27.1±5.7. Overall, 53% had hypertension, 3% diabetes, and 16% were current smokers. Using mixed model regression analyses, higher age (p<0.0001), BMI (p<0.0001), systolic (p<0.0001) and diastolic (p<0.02) blood pressure, and menopausal status (pre-, peri-, and postmenopausal, p=0.006) were significant predictors of higher cIMT but not the rate of cIMT progression over 3 years. Use of exogenous hormone therapy, reproductive hormones, and other risk factors were not predictors. In multivariate modeling, only adjustment for age or systolic blood pressure (but not other covariates) attenuated the effect of menopausal status which became non-significant.
Conclusions: Among women healthy at entry undergoing repeated cIMT measurement in the LAAS, endogenous sex steroids and exogenous hormone use were not related to preclinical atherosclerosis progression.