Sex Differences in Predictors of Longitudinal Changes in Carotid Artery Stiffness

Abstract

Objective To identify sex differences in predictors of longitudinal changes in carotid arterial stiffness in a multi-ethnic cohort. Approach and Results Carotid artery distensibility coefficient (DC) and Young's Elastic Modulus (YEM) were measured in 2650 Multi-Ethnic Study of Atherosclerosis participants (45-84 years old and free of cardiovascular disease) at baseline and after a mean of 9.4 years. Predictors of changes in DC and YEM for each sex were evaluated using multivariable linear regression models. The 1236 men (46.6%) were 60.0 (standard deviation 9.3) years; 40% were White, 22% Black, 16% Chinese, and 22% Hispanic. The 1414 (53.4%) women were 59.8 (9.4) years old with a similar race distribution. Despite similar rates of change in DC and YEM, predictors of changes in distensibility markers differed by sex. In men, Chinese (p=0.002) and Black (p=0.003) race/ethnicity, systolic blood pressure (p=0.012), and diabetes mellitus (p=0.05) were associated with more rapidly decreasing DC (accelerated stiffening). Starting antihypertensive medication was associated with improved DC (p=0.03); stopping anti-hypertensives was associated with more rapid stiffening (increased YEM, p=0.05). In women, higher education was associated with slower stiffening (DC p=0.041; YEM p<0.001) as was use of lipid-lowering medication (p=0.03), whereas baseline use of antihypertensive medications (YEM p=0.01) and systolic blood pressure (DC p=0.02; p=0.04) predicted increasing stiffening in women. Conclusions Longitudinal changes in carotid artery stiffness are associated with systolic blood pressure and antihypertensive therapy in both sexes; however, race/ethnicity (in men) and level of education (in women) may have different contributions between the sexes.

Increased Proximal Aortic Diameter is Associated With Risk of Cardiovascular Events and All‐Cause Mortality in Blacks The Jackson Heart Study

“…On the other hand, AoD was positively associated with systolic and diastolic blood pressure in women. Age‐related changes in arterial characteristics, including stiffness, may be different between men and women, and other factors, including discontinuation of antihypertensive medication, lipid‐lowering medication, and education, might influence the changes 26, 27. Of note, no sex differences were observed in the longitudinal analysis.…”

“…Age-related changes in arterial characteristics, including stiffness, may be different between men and women, and other factors, including discontinuation of antihypertensive medication, lipid-lowering medication, and education, might influence the changes. 26,27 Of note, no sex differences were observed in the longitudinal analysis. Therefore, AoD may be used as a predictor of incident cardiovascular events in both sexes in blacks.…”

Twenty‐Five‐Year Alcohol Consumption Trajectories and Their Association With Arterial Aging: A Prospective Cohort Study

“…To account for potential confounds, known demographic and clinical risk factors for arterial stiffness were selected for inclusion in the modeling. The covariates comprised standard demographic characteristics, including age, sex, and ethnicity . Socioeconomic position was also included and categorized as low, medium, or high according to participants' most recent employment grading.…”

Emerging evidence for accelerated ageing and cardiovascular disease in individuals with cerebral palsy

“…Finally, a significant decrease (1.1E-3 mmHg -1 ) in carotid artery distensibility between baseline and follow-up assessment was observed in our cohort. In a large cohort of men and women free of CVD (45-84 years old), carotid artery distensibility decreased by 0.41E-3 mmHg -1 over a mean period of 9.4 years, and SBP was associated with accelerated stiffening (30). A larger decrease in distensibility that was not associated with age or gross motor function was observed.…”