Coronary and Aortic Calcification Among Women 8 Years After Menopause and Their Premenopausal Risk Factors

Abstract

Abstract-In the Healthy Women Study, the relationship between cardiovascular risk factors measured premenopausally at age 48, use of hormone therapy, and coronary and aortic calcification at age 58 were evaluated among 169 women. Approximately 63% of women had no coronary calcification, but only 29% had no aortic calcification. Coronary calcification and aortic calcification were positively correlated with each other. There was a very strong association between low density lipoprotein cholesterol (LDL-C) level and coronary calcification. Among women with premenopausal levels of LDL-C Ͻ100 mg/dL, only 9% had a coronary calcium score Ն101 compared with 30% of women with an LDL-C Ͼ160 mg/dL. Only 5% of women with a high density lipoprotein cholesterol (HDL-C) level Ͼ60 mg/dL had high coronary scores. The level of HDL 2 -C was especially strongly inversely related to coronary calcium scores. Cigarette smoking was a very important determinant of both high aortic and high coronary calcium scores. Other risk factors associated with greater coronary calcium were higher systolic blood pressure, triglycerides levels, and blood glucose. Use of hormone replacement therapy was associated with less coronary calcium (NS). For both hormone replacement therapy users and nonusers, the levels of LDL-C and HDL-C measured premenopausally were predictors of coronary and aortic calcium scores. Thus, risk factors evaluated premenopausally are powerful predictors of coronary and aortic calcification, a marker of atherosclerosis, measured 8 years after menopause, 11 years later in these women. Key Words: coronary artery disease Ⅲ coronary calcification Ⅲ lipids Ⅲ smoking Ⅲ hormone replacement therapy T he development of new techniques to measure the extent of subclinical cardiovascular disease, such as carotid duplex scanning and electron beam CT (EBCT), has provided important new approaches to study the relationship of risk factors and cardiovascular disease. In this article, we report the relationship between cardiovascular risk factors measured premenopausally and coronary and aortic calcification for 168 women, as measured by EBCT, in the Healthy Women Study (HWS) at the eighth postmenopausal visit. 1,2 In previous reports from the HWS, we evaluated the determinants of changes in cardiovascular risk factors from the premenopause, perimenopause, and postmenopause. 3 There was an increase in LDL cholesterol (LDL-C), little change in total HDL-C, a substantial decline in HDL 2 -C, and an increase in HDL 3 -C. The women gained Ϸ1 pound per year from the perimenopause through the postmenopausal years. Weight gain was associated with a substantial increase in LDL-C, triglycerides, and systolic blood pressure and a decrease in HDL-C levels. 4 In this article, we evaluated 2 hypotheses. First, we predicted that the cardiovascular risk factors that predict clinical cardiovascular disease in elderly women would also predict coronary and aortic calcification in middle-aged women. The extensive risk factor assessment was completed when the women...

The Contribution of Arterial Calcification to Peripheral Arterial Disease in Pseudoxanthoma Elasticum

“…There was no gender difference in PXE, in contrast to the controls where LLAC was more common in men. As expected, the menopausal status was characterized by a higher prevalence of LLAC [19] but it was not influenced by PXE. The prevalence of AC in our study was much higher than the prevalence of 31% reported in a previous semi-quantitative evaluation of AC based on standard X-ray [7], possibly due to the greater accuracy of CT scans in detecting smaller amounts of calcification.…”

Coronary Artery Calcification (CAC) and Post‐Trial Cardiovascular Events and Mortality Within the Women's Health Initiative (WHI) Estrogen‐Alone Trial

“…Among women aged 50 to 59 years at baseline in the WHI E‐Alone Trial, the WHI‐CACS showed that randomization to E‐Alone versus placebo resulted in lower odds of CAC measured ≈8.7 years after baseline, independent of CVD risk factors also associated with subsequent CAC 5. The long incubation period for CAC has been demonstrated by longitudinal studies, showing stronger associations with risk factors measured 11 to 20 years before CAC scan than to concurrently measured risk factors 11, 12, 13. As hypothesized, the association of higher CAC with subsequent CVD events and mortality was not modified by prior randomization to E‐Alone versus placebo and not attenuated by randomized treatment or baseline CVD risk factors.…”

Increased Aortic Calcification Is Associated With Arterial Stiffness Progression in Multiethnic Middle-Aged Men

“…Clinical meaningful cutoff values of aortic calcium scores in the healthy population are unknown, though some investigators use cut points of 100, 300 or 400 14,42 . We used cutoff points of 0, 100 and 400 for baseline aortic calcium, and 0, 10 and 100 for the annual change.…”