Sex differences in longitudinal determinants of carotid intima medial thickening with aging in a community-dwelling population: The baltimore longitudinal study on aging

BACKGROUND: Common carotid intima medial thickness (IMT) increases with aging. However, the longitudinal association between IMT and other age-associated hemodynamic alterations in men and in women are not fully explored. METHODS AND RESULTS: We analyzed repeated measures of IMT, blood pressure, and carotid-femoral pulse wave velocity over a 20-year period in 1067 men and women of the Baltimore Longitudinal Study on Aging; participants were ages 20 to 92 years at entry and free of overt cardiovascular disease. Linear mixed-effects models were used to calculate the individual rates of change (_Change ) of IMT, pulse pressure, mean arterial pressure, and pulse wave velocity, among other covariates. Multivariate regression analysis was used to examine the association of IMT_Change with baseline and rates of change of hemodynamic parameters and cardiovascular risk factors. IMT increased at accelerating rates from 0.02 mm/decade at age 50 years to 0.05 mm/decade at age 80 years greater rates in men than in women. IMT_Change was positively associated with baseline low-density lipoprotein, low-density lipoprotein_Change, and baseline systolic blood pressure and systolic blood pressure_Change, but inversely with baseline diastolic blood pressure and diastolic blood pressure_Change . When blood pressure was expressed as pulse pressure and MAP, IMT_Change was positively associated with baseline pulse pressure and pulse pressure_Change and inversely with baseline mean arterial pressure and mean arterial pressure_Change . In sex-specific analysis, these associations were observed in women, but not in men. CONCLUSIONS: In summary, our analyses showed that IMT increases at accelerating rates with aging. Age-associated changes in IMT were modulated by concurrent changes of low-density lipoprotein in both sexes, and of pulsatile and mean blood pressure in women but not men.