Effect of Stress Echocardiography Testing on Changes in Cardiovascular Risk Behaviors in Postmenopausal Women: A Prospective Survey Study

Abstract

Background: We evaluated the impact of contrast stress echocardiography (CSE) testing results on cardiovascular (CV) risk behaviors in postmenopausal women presenting with chest pain symptoms. This was a substudy of the Stress Echocardiography in Menopausal Women at Risk for Coronary Artery Disease (SMART) trial. Methods: From 2004 to 2007, 366 women (mean age 54.4 -5.5 years, range 40-65; body mass index (BMI) 31.4 -6.68; Caucasian in 95%) completed CSE and were invited to participate in the Women's Heart Clinic Risk Assessment Questionnaire (WHCRAQ survey) at the time of CSE and after 2 years. Of the 366, 203 (55%) postmenopausal women completed both the baseline and 2-year follow-up surveys (age 61 -5 years; Framingham risk score 6 -4%, 81% treadmill CSE, 19% dobutamine CSE). WHCRAQ assessed medical history, hormone therapy (HT), and CV risk behaviors (cigarette smoking history, including current smoking and mean cigarettes smoked per day; physical activity or exercise, including mean exercise minutes per week; and dietary fat intake, alcohol intake, and mean alcohol drinks per week). Abnormal CSE was defined as a new or worsening stress wall motion abnormality. Post-CSE changes in CV risk behaviors were determined by comparing baseline versus 2-year data. Results: Of the 203 women who completed the survey at baseline and 2-year CSE, 29 were excluded to avoid confounding effect (coronary angiography [CA] was performed during follow-up). Of 174 women (55% hypertensive, 10% diabetic, 76% hyperlipidemic, and 25% on HT), CSE was abnormal in 10%. Baseline characteristics were not significantly different in normal versus abnormal CSE, apart from diabetes (8% vs. 24%, p = 0.04). Slightly more women with normal CSE were taking HT than not (27% vs. 12%, p = 0.19). CV risk behaviors that were different in normal versus abnormal CSE included current smoking, alcohol drinks per week, and higher fat diet (8% vs. 24%, p = 0.03; 2.5 -3.5 vs. 1.94 -5.2, p = 0.031; and 92% vs. 76%, p = 0.03, respectively). Cigarette smoking decreased (mean difference of -1.5 cigarettes per day, p = 0.014) in the abnormal-CSE group, whereas number of alcohol drinks per week increased (mean difference + 0.38, p = 0.009) in the normal-CSE group. Conclusion: We observed an association of lifestyle changes with CSE test results in postmenopausal women

Exercise Stress Echocardiography for Stable Coronary Artery Disease: Succumbed to the Modern Conceptual Revolution or Still Alive and Kicking?

“…Additional significant advantages of ESE over other stress imaging modalities include its wide accessibility, portability, low cost since ESE has become widely implemented to assess various conditions other than CAD [ 28 ]. Lifestyle changes with ESE results were observed at 2-year and 5-year follow-up [ 29 , 30 ], suggesting a potential impact of this diagnostic test in primary prevention in women, beyond the immediate diagnostic implications of the test result [ 29 ].…”