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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2008;28:155.)
© 2008 American Heart Association, Inc.

Clinical and Population Studies

Differential Impact of Age, Sex, and Hypertension on Aortic Atherosclerosis

The Framingham Heart Study

Noriko Oyama; Philimon Gona; Carol J. Salton; Michael L. Chuang; Rahul R. Jhaveri; Susan J. Blease; Anya R. Manning; Marc Lahiri; René M. Botnar; Daniel Levy; Martin G. Larson; Christopher J. O’Donnell; Warren J. Manning

From the Departments of Medicine (Cardiovascular Division) (N.O., C.J.S., M.L.C., R.R.J., A.R.M., M.L., R.M.B., D.L., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; the Department of Mathematics and Statistics (P.G., S.J.B., M.G.L.), Boston University; and the National Heart, Lung, and Blood Institute’s Framingham Heart Study (P.G., D.L., M.G.L., C.J.O.), Framingham, Mass.

Correspondence to Warren J. Manning, MD, Cardiovascular Division, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215. E-mail wmanning{at}bidmc.harvard.edu

Abstract

Objective— The purpose of this study was to investigate the impact of age, sex, and hypertension (HTN) on aortic atherosclerotic burden using cardiovascular MRI (CMR) in a free-living longitudinally followed cohort.

Methods and Results— 1763 participants (829 M and 934 F; 38 to 88 years of age) of the Framingham Heart Study Offspring cohort underwent CMR of the thoracoabdominal aorta using an ECG-gated 2D T2-weighted black-blood sequence. Of these, 1726 subjects (96%) with interpretable CMR were characterized by sex, age-quartile, and presence or absence of HTN and clinical cardiovascular disease (CVD). Aortic plaque prevalence and volume increased with increasing age in both sexes. For the nonhypertensive (no-HTN) group, plaque was identified in 702 (46%) with greater prevalence in women than in men (P<0.006). HTN was associated with greater aortic plaque burden (P<0.02). The 200 subjects with clinical CVD had greater plaque burden than subjects without CVD (P<0.0001).

Conclusions— In this free-living longitudinally followed cohort, subclinical aortic atherosclerosis was seen in nearly half of subjects and increased with advancing age. HTN was associated with increased aortic plaque burden. Among no-HTN subjects, women had greater plaque burden than men. These data suggest that subclinical atherosclerosis is more common in no-HTN women and emphasize the importance of focusing on preventive measures in both sexes.

In a free-living cohort, subclinical aortic plaque was seen in nearly half of subjects and increased with age. Hypertension was associated with increased aortic plaque burden. Among nonhypertensive subjects, women had greater plaque burden than men. The data underline the importance of focusing on preventive measures in both sexes.

Key Words: MRI • aortic atherosclerosis • hypertension • age • sex