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

Indu G Poornima; Rachel H Mackey; Matthew A Allison; JoAnn E Manson; J Jeffrey Carr; Michael J LaMonte; Yuefang Chang; Lewis H Kuller; WHI and WHI‐CAC Study Investigators

doi:10.1161/JAHA.117.006887

Back

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

Journal article

Open access

Peer reviewed

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

Indu G Poornima, Rachel H Mackey, Matthew A Allison, JoAnn E Manson, J Jeffrey Carr, Michael J LaMonte, Yuefang Chang, Lewis H Kuller and WHI and WHI‐CAC Study Investigators

Journal of the American Heart Association, Vol.6(11), e006887

10/27/2017

DOI: 10.1161/JAHA.117.006887

PMCID: PMC5721773

PMID: 29079563

Files and links (1)

url

https://doi.org/10.1161/JAHA.117.006887View

Published (Version of record) Open Access

Abstract

Among 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. WHI-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. Among 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. URL: https://www.clinicaltrials.gov. Unique identifier: NCT00000611.

Chi-Square Distribution

Computed Tomography Angiography

Coronary Angiography - methods

Coronary Artery Disease - diagnostic imaging

Coronary Artery Disease - epidemiology

Coronary Artery Disease - mortality

Estrogen Replacement Therapy - adverse effects

Estrogen Replacement Therapy - methods

Estrogen Replacement Therapy - mortality

Estrogens, Conjugated (USP) - administration & dosage

Estrogens, Conjugated (USP) - adverse effects

Female

Humans

Incidence

Middle Aged

Multivariate Analysis

Postmenopause

Proportional Hazards Models

Risk Factors

Time Factors

Treatment Outcome

United States - epidemiology

Vascular Calcification - diagnostic imaging

Vascular Calcification - epidemiology

Vascular Calcification - mortality

Women's Health

Details

Title: Subtitle: Coronary Artery Calcification (CAC) and Post-Trial Cardiovascular Events and Mortality Within the Women's Health Initiative (WHI) Estrogen-Alone Trial
Creators: Indu G Poornima - Allegheny General Hospital
Rachel H Mackey - University of Pittsburgh
Matthew A Allison - University of California San Diego
JoAnn E Manson - Brigham and Women's Hospital
J Jeffrey Carr - Vanderbilt University
Michael J LaMonte - University at Buffalo, State University of New York
Yuefang Chang - University of Pittsburgh
Lewis H Kuller - University of Pittsburgh
WHI and WHI‐CAC Study Investigators
Contributors: J.G Robinson (Contributor) - University of Iowa, Fraternal Order of Eagles Diabetes Research Center
Resource Type: Journal article
Publication Details: Journal of the American Heart Association, Vol.6(11), e006887
DOI: 10.1161/JAHA.117.006887
PMID: 29079563
PMCID: PMC5721773
NLM abbreviation: J Am Heart Assoc
ISSN: 2047-9980
eISSN: 2047-9980
Grant note: UL1 TR001412 / NCATS NIH HHS
Language: English
Date published: 10/27/2017
Academic Unit: Epidemiology; Fraternal Order of Eagles Diabetes Research Center
Record Identifier: 9984364457402771

Metrics

19 Record Views

19 Times Cited - Web of Science