| Title: |
Coronary Artery Calcification (CAC) and Post‐Trial Cardiovascular Events and Mortality Within the Women's Health Initiative (WHI) Estrogen‐Alone Trial |
| Authors: |
Poornima, Indu G; Mackey, Rachel H; Allison, Matthew A; Manson, JoAnn E; Carr, J Jeffrey; LaMonte, Michael J; Chang, Yuefang; Kuller, Lewis H; Rossouw, JE; Ludlam, S; Cochrane, BB; Hunt, JR; Lund, B; Prentice, R; O'Rourke, C; Du, L; Pillsbury, S; Hightower, C; Ellison, R; Tan, J; Wassertheil‐Smoller, S; Magnani, M; Noble, DH; Dellicarpini, T; Bueche, M; McGinnis, AD; Rybicki, FJ; Assaf, AR; Sloane, G; Phillips, LS; Butler, V; Huber, M; Vitali, J; Hsia, J; LeBrun, C; Palm, R; Embersit, D; Whitlock, E; Arnold, K; Sidney, S; Cantrell, V; Kotchen, JM; Feltz, C; Howard, BV; Thomas‐Geevarghese, A; Boggs, G; Jelinick, JS; Greenland, P; Neuman, A; Carlson‐Lund, G; Giovanazzi, SM; Stefanick, ML; Swope, S; Jackson, R; Toussant, K; Lewis, CE; Pierce, P; Stallings, C; Wactawski‐Wende, J; Goel, S; Laughlin, R; Robbins, J; Zaragoza, S; Macias, D; Belisle, D; Nathan, L; Voigt, B; Goldin, J; Woo, M; Langer, RD; Lien, X; Wright, CM; Gass, M; Sheridan, S; Robinson, JG; Feddersen, D; Kelly‐Brake, K; Carroll, J; Ockene, J; Churchill, L; Lasser, NL; Miller, B; Maldjian, PD; Pierre‐Louis, J; Fishman, J; O'Sullivan, MJ; Fernandez, D; Margolis, KL; Bjerk, CL; Truwit, C; Hearity, JA; Hyslop, WB; Darroch, K; Murphy, C; Heiss, G; Edmundowicz, D; Ives, D; Johnson, KC; Satterfield, S; Connelly, SA |
| Source: |
Journal of the American Heart Association, vol 6, iss 11 |
| Publisher Information: |
eScholarship, University of California |
| Publication Year: |
2017 |
| Collection: |
University of California: eScholarship |
| Subject Terms: |
32 Biomedical and Clinical Sciences (for-2020); 3201 Cardiovascular Medicine and Haematology (for-2020); Heart Disease - Coronary Heart Disease (rcdc); Cardiovascular (rcdc); Estrogen (rcdc); Clinical Research (rcdc); Aging (rcdc); Heart Disease (rcdc); Biomedical Imaging (rcdc); Clinical Trials and Supportive Activities (rcdc); Women's Health (rcdc); Cardiovascular (hrcs-hc); 3 Good Health and Well Being (sdg); Chi-Square Distribution (mesh); Computed Tomography Angiography (mesh); Coronary Angiography (mesh); Coronary Artery Disease (mesh); Estrogen Replacement Therapy (mesh); Estrogens; Conjugated (USP) (mesh); Female (mesh); Humans (mesh); Incidence (mesh); Middle Aged (mesh); Multivariate Analysis (mesh); Postmenopause (mesh); Proportional Hazards Models (mesh); Risk Factors (mesh); Time Factors (mesh); Treatment Outcome (mesh) |
| Description: |
BACKGROUND: 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 ≈8.7years 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 RESULTS: WHI-CACS participants (n=1020) were followed ≈8years 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/1000person-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. CONCLUSIONS: 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 ≈8years, independent of baseline randomization to conjugated equine estrogen-alone versus placebo or CVD risk factors. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00000611. |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
unknown |
| Relation: |
qt3js334xb; https://escholarship.org/uc/item/3js334xb; https://escholarship.org/content/qt3js334xb/qt3js334xb.pdf |
| DOI: |
10.1161/jaha.117.006887 |
| Availability: |
https://escholarship.org/uc/item/3js334xb; https://escholarship.org/content/qt3js334xb/qt3js334xb.pdf; https://doi.org/10.1161/jaha.117.006887 |
| Rights: |
CC-BY-NC-ND |
| Accession Number: |
edsbas.E8E37566 |
| Database: |
BASE |