Estimation of Cardiovascular Risk and Detection of Subclinical Carotid Atheromatosis in Middle-aged Postmenopausal Women

pp. 302-307

Abstract

Background

Cardiovascular disease in women increases after menopause. Traditional risk scores

underestimate the risk in postmenopausal women. The diagnosis of carotid atherosclerotic

plaque (CAP) could improve risk stratification.

Objectives

The aim of the study was: 1) to estimate cardiovascular risk in middle-aged postmenopausal

women in primary prevention. 2) To find CAP prevalence. 3) To assess

the precision of risk scores used to detect CAP.

Methods

The level of agreement between the 10-year Framingham risk score (10-FRS) and

the score recommended by the World Health Organization (WHO) was assessed. Ultrasound

was used to determine CAP occurrence. A ROC analysis was performed.

Results

The study included a total of 334 women with mean age 57 Å} 5 years. According to

the 10-FRS and the WHOS, 96% and 91% of the population were respectively classified

as “low risk”. A fair level of agreement between both scores was found (kappa

0.31). CAP occurred in 29% of cases. Score estimated risk correlated with CAP prevalence.

Women with CAP presented higher incidence of hypertension and smoking,

evidencing a more frequent “metabolic” pattern than women without CAP. The area

under the curve of the 10-FRS to detect CAP was 0.79 (95% CI 0.73-0.84), with an

optimal cut-off point ≥ 3%.

Conclusions

In this population, mostly classified as low risk, there was considerable CAP prevalence.

A carotid ultrasound might help to stratify cardiovascular risk when the 10

FRS is ≥ 3%.