Abstract
Objective: To evaluate and compare carotid intima-media thickness (CIMT) between premenopausal and postmenopausal diabetic females using sonographic imaging.
Study design: It was a cross-sectional study.
Place and duration of study: The study was conducted at Saeed Medicare, Gojra, and Samar Diagnostic Lab, Lahore, from August to December 2024.
Material and Methods: This study was carried out on 128 diabetic females, equally divided into premenopausal and postmenopausal groups, aged 40 and above. A stratified purposive sampling method was used to select participants. CIMT measurements were taken using high-resolution ultrasonography, and clinical data including age, BMI, blood glucose levels, and blood pressure were recorded. Data analysis in SPSS version 27 included independent samples t-tests to compare mean CIMT and multiple linear regression to identify key predictors. Effect sizes (Cohen’s d, R²), 95% confidence intervals, and ANOVA within regression were reported, with p < 0.05 considered statistically significant.
Results: A total of 128 participants were included, comprising 64 postmenopausal and 64 premenopausal diabetic females. The mean carotid intima-media thickness (CIMT) was significantly higher in postmenopausal females (1.013 ± 0.17 mm) compared to premenopausal females (0.666 ± 0.17 mm). Blood glucose levels were also elevated in postmenopausal females (239.62 ± 81.08 mg/dL) compared to premenopausal participants (156.25 ± 47.45 mg/dL). Regression analysis identified postmenopausal status (B = 0.709, p < 0.001) and blood glucose levels (B = 0.001, p < 0.001) as significant predictors of increased CIMT, collectively explaining 58.6% of the variation in CIMT (R² = 0.586). Other factors, including BMI, age, and blood pressure, did not show a statistically significant association with CIMT.
Conclusion: The study concludes that postmenopausal diabetic women are at significantly elevated risk for cardiovascular complications due to increased carotid intima-media thickness (CIMT) and higher blood glucose levels compared to premenopausal women. Given that postmenopausal status and hyperglycemia explain a significant proportion of CIMT variation, early vascular screening and strict glycemic control should be prioritized in postmenopausal diabetic women to mitigate cardiovascular risk.
References
Flora GD, Nayak MK. A brief review of cardiovascular diseases, associated risk factors and current treatment regimes. J Curr Pharm Des. 2019;25(38):4063-84.
Behera SS, Pramanik K, Nayak MK. Recent advancement in the treatment of cardiovascular diseases: conventional therapy to nanotechnology. Curr Pharm Des. 2015;21(30):4479-97.
Björkegren JLM, Lusis AJ. Atherosclerosis: recent developments. Cell. 2022;185(10):1630-45.
Bao X, Xu B, Lind L, Engström G. Carotid ultrasound and systematic coronary risk assessment 2 in the prediction of cardiovascular events. Eur J Prev Cardiol. 2023;30(10):1007-14.
Adekoya A, Olatunji A, Akinola R, Odusan O, Adekoya A, Olawale O. Carotid Doppler ultrasonography in patients with co-existing type 2 diabetes mellitus and hypertension in Nigeria. Ann Health Res. 2022;8(1):49-62.
Kupfer R, Larrúbia MR, Bussade I, Pereira JRD, Lima GAB, Epifanio MA, Schettino CDS, Momesso DP. Predictors of subclinical atherosclerosis evaluated by carotid intima-media thickness in asymptomatic young women with type 1 diabetes mellitus. Arch Endocrinol Metab. 2017 Mar-Apr;61(2):115-121.
Guan Y, Yu C, Shi M, Ni J, Wu Y, Gu H, et al. The association between elevated fasting plasma glucose levels and carotid intima-media thickness in non-diabetic adults: A population-based cross-sectional study. Oncotarget. 2017;8(67):111053.
Santoro N, Roeca C, Peters BA, Neal-Perry G. The menopause transition: signs, symptoms, and management options. J Clin Endocrinol Metab. 2021;106(1):1-15.
Blenck CL, Harvey PA, Reckelhoff JF, Leinwand LA. The importance of biological sex and estrogen in rodent models of cardiovascular health and disease. J Cardiovasc Res. 2016;118(8):1294-1312.
Leis AM, Jackson EA, Baylin A, Barinas-Mitchell E, El Khoudary SR, Karvonen-Gutierrez CA. Carotid intima media thickness and cardiometabolic dysfunction: the Study of Women's Health Across the Nation. Menopause. 2023;30(12):1190-1198.
Wu CZ, Huang LY, Chen FY, Kuo CH, Yeih DF. Using machine learning to predict abnormal carotid intima-media thickness in type 2 diabetes. Diagnostics (Basel). 2023;13(11):1834.
Zhou Y-Y, Qiu H-M, Yang Y, Han Y-Y. Analysis of risk factors for carotid intima-media thickness in patients with type 2 diabetes mellitus. Diabetology & Metabolic Syndrome. 2020;12:1-13.
Kanwal HI, Shahid M, Bacha R. Sonographic assessment of intima-media thickness of carotid arteries in hypertensive and diabetic volunteers. J Diagn Med Sonogr. 2024;40(1):20-27.
Umeh E, Agunloye A, Adekanmi A, Adeyinka A. Ultrasound evaluation of intima-media thickness of carotid arteries in adults with primary hypertension at Ibadan, Nigeria. West Afr J Med. 2013;32(1):62–67.
Willeit P, Tschiderer L, Allara E, Reuber K, Seekircher L, Gao L, et al. Carotid intima-media thickness progression as surrogate marker for cardiovascular risk: meta-analysis of 119 clinical trials involving 100 667 patients. Circulation. 2020 Aug 18;142(7):621-42.
Lorenz MW, Polak JF, Kavousi M, Mathiesen EB, Völzke H, Tuomainen TP, Sander D, Plichart M, Catapano AL, Robertson CM, Kiechl S, Rundek T, Desvarieux M, Lind L, Schmid C, DasMahapatra P, Gao L, Ziegelbauer K, Bots ML, Thompson SG; PROG-IMT Study Group. Carotid intima-media thickness progression to predict cardiovascular events in the general population (the PROG-IMT collaborative project): a meta-analysis of individual participant data. Lancet. 2012 Jun 2;379(9831):2053-62.
van den Munckhof ICL, Jones H, Hopman MTE, de Graaf J, Nyakayiru J, van Dijk B, Eijsvogels TMH, Thijssen DHJ. Relation between age and carotid artery intima-medial thickness: a systematic review. Clin Cardiol. 2018 May;41(5):698-704.
Guan Y, Yu C, Shi M, Ni J, Wu Y, Gu H, Bai L, Liu J, Tu J, Wang J, Ning X. The association between elevated fasting plasma glucose levels and carotid intima-media thickness in non-diabetic adults: a population-based cross-sectional study. Oncotarget. 2017 Nov 6;8(67):111053-63.
Zhou YY, Qiu HM, Yang Y, Han YY. Analysis of risk factors for carotid intima-media thickness in patients with type 2 diabetes mellitus in Western China assessed by logistic regression combined with a decision tree model. Diabetol Metab Syndr. 2020 Jan 28;12:8.
Berraho M, El Achhab Y, Benslimane A, El Rhazi K, Chikri M, Nejjari C. Hypertension and type 2 diabetes: a cross-sectional study in Morocco. Pan Afr Med J. 2012;11:52.
Hussin M, Ali N, Elsaraf N, Azzam H, Rashed L. AACE2021-A-1050: Relationship of Serum Level of Bone Formation Biomarker Osteocalcin and CIMT and Metabolic Parameters in Post-Menopausal Females and Type 2 Diabetes. Endocrine Practice. 2021 Dec 1;27(12):S44-5.
Yusuf, S., Joseph, P., Rangarajan, S., et al. (2020). Modifiable risk factors, cardiovascular disease, and mortality in 155,722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. The Lancet, 395(10226), 795-808.
Wang, Y., Li, L., Gao, Y., et al. (2019). Genetic Predisposition to Type 2 Diabetes and Risk of Subclinical Atherosclerosis: A Mendelian Randomization Study. Diabetes, 68(5), 885-894.
Ayub S, Rahim A, Afzal M, Jahan S, Hasan A, Zainub A. Comparison of asymmetric dimethylarginine levels between pre-and post-menopausal women—a cross-sectional study from Rawalpindi. JPMA. 2019 Dec 1;69(12):1808-11.
Martens T, Beck RW, Bailey R, Ruedy KJ, Calhoun P, Peters AL, Pop-Busui R, Philis-Tsimikas A, Bao S, Umpierrez G, Davis G, Kruger D, Bhargava A, Young L, McGill JB, Aleppo G, Nguyen QT, Orozco I, Biggs W, Lucas KJ, Polonsky WH, Buse JB, Price D, Bergenstal RM; MOBILE Study Group. Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin: A Randomized Clinical Trial. JAMA. 2021 Jun 8;325(22):2262-72.

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) 2025 Journal of Nursing and Allied Health