Progression rates of carotid intima-media thickness and adventitial diameter during the menopausal transition

Objective: The aim of this study is to assess whether the levels and progression rates of carotid intima-media thickness (IMT) and adventitial diameter (AD) vary by menopausal stage. Methods: Two hundred forty-nine women (aged 42-57 y; 49% premenopausal and 46% early perimenopausal) from the Study of Women's Health Across the Nation were included in the current analysis. Participants were followed up for up to 9 years (median, 3.7 y) and underwent up to five carotid scans. Linear mixed-effect models were used for the analysis. Results: The overall rate of change in IMT was 0.007 mm/year. Independent of age and race, the progression rate of IMT increased substantially in the late perimenopausal stage (0.017 mm/y) compared with both the premenopausal stage (0.007 mm/y) and the early perimenopausal stage (0.005 mm/y; P <= 0.05). For AD, although the overall rate of change was negative (-0.009 mm/y), significant positive increases in the rate of change were observed in the late perimenopausal stage (0.024 mm/y) and the postmenopausal stage (0.018 mm/y) compared with the premenopausal stage (-0.032 mm/y; P < 0.05). In the final models, the postmenopausal stage was independently associated with higher levels of IMT and AD (P < 0.05) compared with the premenopausal stage. Conclusions: During the menopausal transition, the carotid artery undergoes adaptation that is reflected in adverse changes in IMT and AD. These changes may have an impact on the vulnerability of the vessel to disease in older women.