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Association between carotid artery atherosclerosis and coronary artery disease in young females. Reference to sex hormone profile.

BACKGROUND
Atherosclerosis of coronary and peripheral arteries occurs rarely in premenopausal women. It has been postulated that sex hormones protect the vascular wall.


AIM
To evaluate whether ultrasound assessment of the changes in the wall of carotid arteries provides any useful information on the severity of atherosclerosis of the coronary vessels as well as whether the atherosclerotic changes in the wall of carotid arteries are accompanied by oestrogen insufficiency in the premenopausal age.


METHODS
The studied group consisted of 65 regularly menstruating women: 21 with coronary artery disease (CAD) revealed by angiography or after myocardial infarction (mean age 44 years)--the CAD group; and 44 healthy woman (mean age 43 years)--the control group. The severity of atherosclerotic changes was determined based on computer-assisted measurement of the intima-media complex thickness (IMC-T) in the common carotid artery. In all women prospective measurement of sex hormone profile was done with enzymatic immunoassay: oestradiol at day 7-9 and day 19-21 of the menstrual cycle and follicle-stimulating hormone (FSH).


RESULTS
The IMC-T value was greater in the CAD group than the control group (0.696+/-0.124 mm and 0.518+/-0.064 mm respectively, p=0.001). The IMC-T (>0.6 mm) was a good indicator of the occurrence of CAD (OR 15.6, 95% CI 3.65-71.1, p <0.0001), with a sensitivity of 73.7% and a specificity of 84.8%. There was a negative correlation between oestradiol level at day 19-21 of the menstrual cycle and IMC-T (r=-0.28, p=0.05).


CONCLUSIONS
The IMC-T value >0.6 mm was found to be a sensitive and specific ultrasound parameter that can be useful in detecting the presence of CAD in premenopausal women. The results of the study also suggest a possible association between hormonal profile and early atherosclerotic changes in carotid arteries in premenopausal women.