Thursday, September 26, 2002

This presentation is part of : Posters

Use of Carotid-Intima Wall Thickness for Cardiovascular Risk Assessment in Postmenopausal Women

Sue M. Penckofer, RN, PhD, professor and associate dean for research1, Dusty Filliung, RVT, undergraduate nursing student1, and Nicos Labropoulos, PhD, RVT, assistant professor2. (1) Department of Health Promotion, Primary Care, and Dietetics, Loyola University Chicago, Maywood, IL, USA, (2) Department of Surgery, Division of Peripheral Vascular Surgery, Loyola University Medical Center, USA

Coronary heart disease is the leading cause of death in postmenopausal(PMP)women. Women with type 2 diabetes are six times more likely to have fatal and nonfatal heart disease than women without diabetes. Carotid intima-media (IMT) wall thickness is a reliabile, noninvasive method to evaluate cardiovascular risk. Increased carotid IMT has been directly associated with an increased risk for cardiovascular events (e.g., myocardial infarction and stroke) in adults without a history of cardiovascular disease. This study used carotid IMT to assess for cardiovascular risk in 20 PMP women with type 2 diabetes and 20 PMP without type 2 diabetes. Only women without known cardiovascular disease were eligible to participate. Carotid scans for IMT measurement were performed by B-mode imaging of the high resolution ultrasound scanner, using a 7Mhz array transducer. Anterior, anterior-lateral, and posterior-lateral projections were used to image the left and right common carotid arteries (CCA). The image focused on the the far right wall of the right CCA that demonstrated the thickest area and was 2cm proximal to the flow divider. The IMT measurement was done three times using the same projection for the right CCA. The same procedure was followed for the left CCA. For the IMT measure, the six measurements (3 from the right CCA and 3 from the left CCA) were averaged, as has been previously reported. Our inter- and intra-coefficient of variation (CV) was less than 6% (less than 10% is acceptable). Self-report measures of demographic and health information (elevated cholesterol, hypertesion, diabetes, level of physical activity, height, weight, years menopausal, and estrogen use) were also taken. Findings indicated that mean carotid IMT was 0.88mm for PMP with type 2 diabetes and 0.74mm for PMP without type 2 diabetes (p=.001). A mean carotid IMT of 0.75mm has been reported for women who are more than 5 years PMP. There were no significant differences between groups on age, race, level or activity, or increased cholesterol. Women with type 2 diabetes, however, reported more hypertension (p=.004), greater body mass index (p=.026), and less estrogen use (p=.027). In addition, 10% of the women with type 2 diabetes had a significant stenosis of the carotid artery that later required surgical intervention. Our study suggests that carotid IMT is a valuable way to screen for cardiovascular risk. It has been used as a surrogate endpoint for clinical trial research involving lipid lowering medications (e.g., statins). It may also be a feasible, noninvasive method for monitoring the effectiveness of nursing interventions (e.g., diet, and physical activity) in the prevention and treatment of cardiovascular disease.

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