A Threshold Study of Carotid Plaque Risk in Postmenopausal Middle-aged Women with Normal Homocysteine

Abstract

Background Carotid plaque is an important early predictive signal of clinical carotid atherosclerosis, the association between homocysteine (Hcy) and carotid plaque is well recognized, however, the correlation between Hcy and carotid plaque in postmenopausal middle-aged women is not established. Objective To analyze the impact of Hcy within the normal reference range on the risk of carotid plaque in postmenopausal middle-aged women and determine the risk threshold. Methods A total of 1 465 postmenopausal women (Hcy<15 μmol/L) who underwent health examinations at the Affiliated Hospital of Guizhou Medical University between January 2020 and June 2023 were randomly selected. The general information, blood biochemical indicators, and carotid ultrasound indicators of patients were collected, and multivariate Logistic regression analysis was used to explore the association between Hcy and carotid plaque. The cutoff value of Hcy for predicting the risk of carotid plaque in postmenopausal middle-aged women with normal Hcy range was determined by plotting the receiver operating characteristic (ROC) curve. Results Six hundred and forty-four (43.96%) out of 1 465 study subjects had carotid artery plaques. Age, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triacylglycerol (TG), and Hcy were higher in the plaque group than in the non-plaque group, high-density lipoprotein cholesterol (HDL-C) was lower than in the non-plaque group (P<0.05). Logistic regression analysis showed that age (OR=1.100, 95%CI=1.070-1.130), SBP (OR=1.021, 95%CI=1.012-1.030), LDL-C (OR=1.232, 95%CI=1.077-1.411), HDL-C (OR=0.568, 95%CI=0.387-0.835) and Hcy (OR=1.142, 95%CI=1.080-1.207) were independent risk factors for carotid plaque in postmenopausal middle-aged women. ROC curve analysis indicated that Hcy≥11.87 μmol/L was the optimal cutoff value for predicting carotid plaque in postmenopausal middle-aged women within the normal Hcy range, with the area under curve (AUC) of 0.605, specificity of 75.8% and sensitivity of 40.4%. Conclusion Hcy is an independent risk factor for carotid plaque in postmenopausal middle-aged women, and Hcy≥11.87 μmol/L is the optimal cutoff value for predicting carotid plaque in postmenopausal middle-aged women with normal Hcy. This threshold may provide an important reference for clinical assessment of carotid plaque risk in postmenopausal middle-aged women.

Keywords

• carotid plaques|carotid stenosis|postmenopause|homocysteine|threshold