title: Sex differences in predictors of longitudinal changes in carotid artery stiffness: the Multi-Ethnic Study of Atherosclerosis.
abstract: OBJECTIVE
  To identify sex differences in predictors of longitudinal changes in carotid arterial stiffness in a multiethnic cohort.
  
  
  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 (SD, 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 antihypertensives 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.
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison (R.S., M.C.T., A.D.G., C.E.K., J.H.S.); Department of Epidemiology, University of Washington School of Public Health, Seattle (J.K.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.A.C., K.L.).
authors.forename: Rebecca
authors.initials: R
authors.lastname: Stern
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison (R.S., M.C.T., A.D.G., C.E.K., J.H.S.); Department of Epidemiology, University of Washington School of Public Health, Seattle (J.K.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.A.C., K.L.).
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Tattersall
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison (R.S., M.C.T., A.D.G., C.E.K., J.H.S.); Department of Epidemiology, University of Washington School of Public Health, Seattle (J.K.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.A.C., K.L.).
authors.forename: Adam D
authors.initials: AD
authors.lastname: Gepner
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison (R.S., M.C.T., A.D.G., C.E.K., J.H.S.); Department of Epidemiology, University of Washington School of Public Health, Seattle (J.K.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.A.C., K.L.).
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Korcarz
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison (R.S., M.C.T., A.D.G., C.E.K., J.H.S.); Department of Epidemiology, University of Washington School of Public Health, Seattle (J.K.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.A.C., K.L.).
authors.forename: Joel
authors.initials: J
authors.lastname: Kaufman
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison (R.S., M.C.T., A.D.G., C.E.K., J.H.S.); Department of Epidemiology, University of Washington School of Public Health, Seattle (J.K.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.A.C., K.L.).
authors.forename: Laura A
authors.initials: LA
authors.lastname: Colangelo
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison (R.S., M.C.T., A.D.G., C.E.K., J.H.S.); Department of Epidemiology, University of Washington School of Public Health, Seattle (J.K.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.A.C., K.L.).
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.affiliation: From the Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison (R.S., M.C.T., A.D.G., C.E.K., J.H.S.); Department of Epidemiology, University of Washington School of Public Health, Seattle (J.K.); and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.A.C., K.L.). jhs@medicine.wisc.edu.
authors.forename: James H
authors.initials: JH
authors.lastname: Stein
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D050197:Atherosclerosis / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology / Q000503:physiopathology*; D001794:Blood Pressure; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology / Q000503:physiopathology*; D016009:Chi-Square Distribution; D004522:Educational Status; D055119:Elastic Modulus; D005006:Ethnicity; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D044469:Racial Groups; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014463:Ultrasonography; D014481:United States; D059289:Vascular Stiffness / Q000187:drug effects
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents
keywords: cardiovascular diseases; carotid arteries; sex characteristics; vascular stiffness; women