Response to the paper by Carranza-Lira S et al. The relationship between carotid intima-media thickness and cognitive function and depression in postmenopausal women. Prz Menopauz 2023; 22: 21-23

Dear Editor,
Carranza-Lira et al. published in a recent issue of Menopause Review an article titled The relationship between carotid intima-media thickness and cognitive function and depression in postmenopausal women [1].
The authors wrote: Atherosclerosis, cognitive impairment, and depression are common entities in postmenopausal patients. Our aim was to ascertain the relationship between the carotid intima-media thickness (IMT) and cognitive function and depression in postmenopausal women [1].
Seventy-five patients (with a median age of 52 years) were included in their observational, cross-sectional, comparative study among postmenopausal women. To assess for mental function the mini-mental state examination and for depression the Hamilton depression rating scale were used [1].
Intima-media thickness ultrasound was performed in all subjects.
Intima-media thickness was greater in the group with depression (n = 45) than in the group without depression (n = 30) (IMT 1.2 mm [0.7–2.0 mm] vs. IMT 0.9 mm [0.6–1.9 mm] p-value 0.001); IMT was greater in the group with cognitive impairment (n = 19) than in the group without cognitive impairment (n = 56) (IMT 1.5 mm [0.7–2.0 mm] vs. 1.0 mm [0.6–1.9 mm] p-value 0.001) [1].
The authors concluded that increased IMT is associated with a higher risk of depression and cognitive impairment [1].
Some comments are needed to evaluate the results and conclusions of this study in a more balanced way.

Carotid intima-media thickness measurement protocol

The authors wrote, Carotid artery ultrasound was performed in all subjects, and the IMT was evaluated as follows: in the soft tissue category, locating the carotid artery 1 cm from its bifurcation, the image was maximized by visualizing on the screen the diameter of the lumen of the vessel and then measuring the distance between the first and second echogenic lines. The highest value obtained was used for the analysis [1].
The carotid IMT (cIMT) measurement protocol is still a controversial matter [2, 3]. Some authors recommend cIMT data acquisition at a single location, preferably at the distal (far) wall of the common carotid artery (CCA) for the higher spatial resolution with respect the proximal (near) wall, in a plaque-free area in proximity of the bifurcation [2]; or cIMT can be measured at multiple sites (CCA, bifurcation and the internal CA) [4]. Measurements can be performed manually or with an...


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