Age and sex differences in the relationship between inherited and lifestyle risk factors and subclinical carotid atherosclerosis: the Tromsø study.

BACKGROUND Ultrasound measurement of carotid artery intima-media thickness (IMT) is regarded as a valid index of atherosclerosis. Age and sex differences in the distribution of, and risk factors for, IMT have not been investigated thoroughly. METHODS In 1994-1995 a total of 6408 men and women aged 25-84 years living in the municipality of Tromsø, Norway, underwent ultrasound examination of carotid artery IMT and measurements of cardiovascular risk factors. RESULTS Age, systolic blood pressure, total cholesterol, HDL cholesterol, body mass index, and smoking were independent predictors of IMT in both sexes. Fibrinogen levels and physical activity were associated with IMT in men only, whereas triglyceride levels were associated with IMT independently of HDL cholesterol in women only. A family history of cardiovascular disease (CVD) was an independent predictor of IMT in both sexes, also when controlling for traditional CVD risk factors. The magnitude of the association between most risk factors and IMT did not differ depending on age, but the effects of physical activity and triglycerides were more pronounced at higher age. CONCLUSION These data suggest that there are significant age and sex differences in the distribution and the determinants of subclinical atherosclerosis.

[1]  P. Talmud,et al.  The genetic determinants of plasma cholesterol and response to diet. , 1995, Bailliere's clinical endocrinology and metabolism.

[2]  J. Hokanson,et al.  Plasma Triglyceride Level is a Risk Factor for Cardiovascular Disease Independent of High-Density Lipoprotein Cholesterol Level: A Metaanalysis of Population-Based Prospective Studies , 1996, Journal of cardiovascular risk.

[3]  K J Rothman,et al.  No Adjustments Are Needed for Multiple Comparisons , 1990, Epidemiology.

[4]  R Peto,et al.  Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. , 1998, JAMA.

[5]  P M Rautaharju,et al.  Arterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults. The Atherosclerosis Risk in Communities (ARIC) Study. , 1995, Stroke.

[6]  C. Carter,et al.  Inheritance of congenital pyloric stenosis. , 1969, British medical bulletin.

[7]  T. Manolio,et al.  Does the association of risk factors and atherosclerosis change with age? An analysis of the combined ARIC and CHS cohorts. The Atherosclerosis Risk in Communities (ARIC) and Cardiovascular Health Study (CHS) investigators. , 1997, Stroke.

[8]  A. Rissanen,et al.  Family history as a risk factor of coronary heart disease in patients under 60 years of age. , 1998, European heart journal.

[9]  E. Barrett-Connor.  Sex differences in coronary heart disease. Why are women so superior? The 1995 Ancel Keys Lecture. , 1997, Circulation.

[10]  A. Folsom,et al.  Prospective study of hemostatic factors and incidence of coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study. , 1997, Circulation.

[11]  M. Province,et al.  Familial history of stroke and stroke risk. The Family Heart Study. , 1997, Stroke.

[12]  H. Dustan,et al.  Atherosclerosis Complicating Chronic Hypertension , 1974 .

[13]  A. Folsom,et al.  Population correlates of plasma fibrinogen and factor VII, putative cardiovascular risk factors. , 1991, Atherosclerosis.

[14]  J. Björkegren,et al.  Alimentary lipemia, postprandial triglyceride-rich lipoproteins, and common carotid intima-media thickness in healthy, middle-aged men. , 1999, Circulation.

[15]  R. D'Agostino,et al.  Fibrinogen and risk of cardiovascular disease. The Framingham Study. , 1987, JAMA.

[16]  R. Frye,et al.  A population-based model of risk factors for ischemic stroke , 1996, Neurology.

[17]  J. Pell,et al.  Sex differences in susceptibility to etiologic factors for peripheral atherosclerosis. Importance of plasma fibrinogen and blood viscosity. , 1994, Arteriosclerosis and thrombosis : a journal of vascular biology.

[18]  R. D'Agostino,et al.  Physical activity and mortality in women in the Framingham Heart Study. , 1994, American heart journal.

[19]  D. Levy,et al.  Lipids and risk of coronary heart disease. The Framingham Study. , 1992, Annals of epidemiology.

[20]  Richard A. Kronmal,et al.  Distribution and Correlates of Sonographically Detected Carotid Artery Disease in the Cardiovascular Health Study , 1992, Stroke.

[21]  L. Chambless,et al.  Carotid atherosclerosis measured by B-mode ultrasound in populations: associations with cardiovascular risk factors in the ARIC study. , 1991, American journal of epidemiology.

[22]  A. Hofman,et al.  Common carotid intima-media thickness and lower extremity arterial atherosclerosis. The Rotterdam Study. , 1994, Arteriosclerosis and thrombosis : a journal of vascular biology.

[23]  D. Reed,et al.  Do coronary heart disease risk factors measured in the elderly have the same predictive roles as in the middle aged. Comparisons of relative and attributable risks. , 1992, Annals of epidemiology.

[24]  Albert Hofman,et al.  Increased common carotid intima-media thickness. Adaptive response or a reflection of atherosclerosis? Findings from the Rotterdam Study. , 1997, Stroke.

[25]  C. Bengtsson,et al.  Socioeconomic factors and physical activity in relation to cardiovascular disease and death. A 12 year follow up of participants in a population study of women in Gothenburg, Sweden. , 1986, British heart journal.

[26]  G A Colditz,et al.  A meta-analysis of physical activity in the prevention of coronary heart disease. , 1990, American journal of epidemiology.

[27]  O. Joakimsen,et al.  Reproducibility of ultrasonographically determined intima-media thickness is dependent on arterial wall thickness. The Tromsø Study. , 1997, Stroke.

[28]  P. Wolf,et al.  Physical activity and stroke risk: the Framingham Study. , 1994, American journal of epidemiology.

[29]  R. Krauss,et al.  Intermediate-density lipoproteins and progression of carotid arterial wall intima-media thickness. , 1997, Circulation.

[30]  J. Salonen,et al.  Determinants of carotid intima‐media thickness: a population‐based ultrasonography study in Eastern Finnish men , 1991, Journal of internal medicine.

[31]  R S Paffenbarger,et al.  Epidemiology of exercise and coronary heart disease. , 1984, Clinics in sports medicine.

[32]  P L Allan,et al.  Blood viscosity and elevated carotid intima-media thickness in men and women: the Edinburgh Artery Study. , 1998, Circulation.

[33]  C. Burchfiel,et al.  Physical activity in older middle-aged men and reduced risk of stroke: the Honolulu Heart Program. , 1994, American journal of epidemiology.

[34]  L Guize,et al.  Risk factors for early carotid atherosclerosis in middle-aged French women. , 1991, Arteriosclerosis and thrombosis : a journal of vascular biology.

[35]  S. Harrap.  Hypertension: genes versus environment , 1994, The Lancet.

[36]  K. Bønaa,et al.  Association Between Heart Rate and Atherogenic Blood Lipid Fractions in a Population: The Tromsø Study , 1992, Circulation.

[37]  C. la Vecchia,et al.  Role of Family History in Patients With Myocardial Infarction: An Italian Case–Control Study , 1992, Circulation.

[38]  P. Touboul,et al.  Differential association of common carotid intima-media thickness and carotid atherosclerotic plaques with parental history of premature death from coronary heart disease : the EVA study. , 1999, Arteriosclerosis, thrombosis, and vascular biology.

[39]  J. Staessen,et al.  Isolated systolic hypertension in the elderly. , 1990, Journal of hypertension.

[40]  A. Folsom,et al.  Relation of Carotid Artery Wall Thickness to Diabetes Mellitus, Fasting Glucose and Insulin, Body Size, and Physical Activity , 1994, Stroke.

[41]  P. Savage,et al.  Fibrinogen and factor VIII, but not factor VII, are associated with measures of subclinical cardiovascular disease in the elderly. Results from The Cardiovascular Health Study. , 1995, Arteriosclerosis, thrombosis, and vascular biology.

[42]  Stephenie P. Joyner.  SAS/STAT guide for personal computers, version 6 edition , 1985 .

[43]  M. Bond,et al.  Association of coronary disease with segment-specific intimal-medial thickening of the extracranial carotid artery. , 1995, Circulation.