Premenopausal risk factors for coronary and aortic calcification: A 20-year follow-up in the healthy women study

Matthews, Karen A.; Kuller, Lewis H.; Chang, Yue‐Fang; Edmundowicz, Daniel

doi:10.1016/j.ypmed.2007.07.002

Cited by 31 publications

(20 citation statements)

References 34 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Poornima

Mackey

Allison

et al. 2017

JAHA

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BackgroundAmong women aged 50 to 59 years at baseline in the Women's Health Initiative (WHI) Estrogen‐Alone (E‐Alone) trial, randomization to conjugated equine estrogen‐alone versus placebo was associated with lower risk of myocardial infarction and mortality, and, in an ancillary study, the WHI‐CACS (WHI Coronary Artery Calcification Study) with lower CAC, measured by cardiac computed tomography ≈8.7 years after baseline randomization. We hypothesized that higher CAC would be related to post‐trial coronary heart disease (CHD), cardiovascular disease (CVD), and total mortality, independent of baseline randomization or risk factors.Methods and ResultsWHI‐CACS participants (n=1020) were followed ≈8 years from computed tomography scan in 2005 (mean age=64.4) through 2013 for incident CHD (myocardial infarction and fatal CHD, n=17), CVD (n=69), and total mortality (n=55). Incident CHD and CVD analyses excluded women with CVD before scan (n=89). Women with CAC=0 (n=54%) had very low age‐adjusted rates/1000 person‐years of CHD (0.91), CVD (5.56), and mortality (3.45). In comparison, rates were ≈2‐fold higher for women with any CAC (>0). Associations were not modified by baseline randomization to conjugated equine estrogen–alone versus placebo. Adjusted for baseline randomization and risk factors, the hazard ratio (95% confidence interval) for CAC >100 (19%) was 4.06 (2.11, 7.80) for CVD and 2.70 (1.26, 5.79) for mortality.ConclusionsAmong a subset of postmenopausal women aged 50 to 59 years at baseline in the WHI E‐Alone Trial, CAC at mean age of 64 years was strongly related to incident CHD, CVD, and to total mortality over ≈8 years, independent of baseline randomization to conjugated equine estrogen–alone versus placebo or CVD risk factors.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT00000611.

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Section: Discussionmentioning

confidence: 99%

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

Poornima

Mackey

Allison

et al. 2017

JAHA

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“…20 The models allowed estimation of the odds of being in a higher CAC score category compared with a lower CAC score category. Models were fit with the same risk factors and renal function measures as described.…”

Section: Methodsmentioning

confidence: 99%

“…38 Total CAC score was used to define categories of CAC extent based on cutoff points previously defined in women that are associated with increased risk of MI (0, 1-10, 11-100, and >100). 20 To reduce nonnormality, the total CAC score was natural log transformed after adding 1.…”

Section: Measurement Of Cacmentioning

confidence: 99%

“…The extent of CAC predicts the risk of CHD events. [18][19][20] Albuminuria among older (mean age 63 years) 21 but not younger adults (mean age 44 years) 22 and glomerular filtration rate (GFR) 23 are each associated with CAC presence and extent. Albuminuria is a potent predictor of future cardiovascular events, even among persons with a normal GFR.…”

Section: Introductionmentioning

confidence: 99%

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Hypertension during Pregnancy is Associated with Coronary Artery Calcium Independent of Renal Function

Cassidy‐Bushrow

Bielak

Rule

et al. 2009

Journal of Women's Health

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Background: Hypertension during pregnancy (HDP) increases the risk of future coronary heart disease (CHD), but it is unknown whether this association is mediated by renal injury. Reduced renal function is both a complication of HDP and a risk factor for CHD. Methods: Logistic regression models were fit to examine the association between a history of HDP and the presence and extent of coronary artery calcification (CAC), a measure of subclinical coronary artery atherosclerosis, in 498 women from the Epidemiology of Coronary Artery Calcification Study (mean age 63.3 AE 9.3 years). Results: Fifty-two (10.4%) women reported a history of HDP. After adjusting for age at time of study participation, HDP was associated with increased serum creatinine later in life ( p ¼ 0.014). HDP was positively associated with the presence of CAC after adjusting for age at time of study participation (OR ¼ 2.7, 95% CI 1.4-5.4). This association was slightly attenuated with adjustment for body size and blood pressure (OR ¼ 2.4, 95% CI 1.2-4.9) but was not further attenuated with adjustment for serum creatinine and urinary albumin=creatinine ratio (OR ¼ 2.6, 95% CI 1.3-5.3). Results were similar for CAC extent. Conclusions: HDP may increase a woman's risk of future CHD beyond traditional risk factors and renal function. Women with a history of HDP should be monitored for potential increased risk of CHD as they age.

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“…We have also reported that the amount of coronary or aortic calcification was a significant risk factor for incident coronary heart disease (CHD) in the HWS. (3) In 2002, we presented the initial abstract on progression of coronary atherosclerosis over 2.8 years in the HWS. Of 86 women with 0 CAC at the 1 st EBT, 19%, about 6% per year, had new CAC.…”

Section: Introductionmentioning

confidence: 99%

Incident coronary artery calcium among postmenopausal women

et al. 2008

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Recent studies have shown that individuals with 0 coronary artery calcium (CAC) scores have very low risk of coronary heart disease. In the Healthy Women Study, we evaluated development of new CAC among postmenopausal women (n=272) over a 6 year period, age 62 at the 1 st and 68 at the 3 rd electron beam tomography (EBT) examination. At the 1 st EBT, 155 of 272 (57%) women had 0 CAC. By the 3 rd , 56 (36%) of these women had developed new CAC, including 38 with >5 Agatston units. There was practically no regression from having CAC at with the 1 st EBT to no CAC at the 3 rd EBT. The risk of developing new CAC over 6 years among women with 0 CAC on their 1 st EBT was strongly and significantly related to presence of both aortic calcium and carotid plaque at the time of 1 st EBT. Baseline premenopausal risk factors, age 47, apolipoprotein B, body mass index (BMI) and triglycerides, were significant predictors of incident CAC as were the changes in BMI and low density lipoprotein cholesterol between premenopause and the 1 st post exam, age 53. Risk factors measured premenopause and change in risk factors from premenopause to the 1 st post exam and the extent of subclinical disease in other vascular beds are primary determinants of the risk of developing incident CAC in women over a 6 year period.

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Premenopausal risk factors for coronary and aortic calcification: A 20-year follow-up in the healthy women study

Cited by 31 publications

References 34 publications

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

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

Hypertension during Pregnancy is Associated with Coronary Artery Calcium Independent of Renal Function

Incident coronary artery calcium among postmenopausal women

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