Coronary Artery Calcification (CAC) and post-trial cardiovascular events and mortality within the Women's Health Initiative (WHI) estrogen-alone trial

for the WHI and WHI-CAC Study Investigators

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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 ≈8.7 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 Results--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 ageadjusted 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. 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 ≈8 years, independent of baseline randomization to conjugated equine estrogen-alone versus placebo or CVD risk factors.

Original languageEnglish (US)
Article numbere006887
JournalJournal of the American Heart Association
Volume6
Issue number11
DOIs
StatePublished - Nov 1 2017

Fingerprint

Women's Health
Coronary Vessels
Estrogens
Cardiovascular Diseases
Random Allocation
Coronary Disease
Mortality
Conjugated (USP) Estrogens
Placebos
Myocardial Infarction
Tomography
Confidence Intervals

Keywords

  • Cardiovascular disease
  • Coronary artery calcification
  • Hormonal therapy
  • Mortality
  • Women

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Coronary Artery Calcification (CAC) and post-trial cardiovascular events and mortality within the Women's Health Initiative (WHI) estrogen-alone trial. / for the WHI and WHI-CAC Study Investigators.

In: Journal of the American Heart Association, Vol. 6, No. 11, e006887, 01.11.2017.

Research output: Contribution to journalArticle

@article{408dcecf0b61474bbe77da1befdbfdb6,
title = "Coronary Artery Calcification (CAC) and post-trial cardiovascular events and mortality within the Women's Health Initiative (WHI) estrogen-alone trial",
abstract = "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 ≈8.7 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 Results--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 ageadjusted 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. 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 ≈8 years, independent of baseline randomization to conjugated equine estrogen-alone versus placebo or CVD risk factors.",
keywords = "Cardiovascular disease, Coronary artery calcification, Hormonal therapy, Mortality, Women",
author = "{for the WHI and WHI-CAC Study Investigators} and Poornima, {Indu G.} and Mackey, {Rachel H.} and Allison, {Matthew A.} and Manson, {Jo Ann E.} and Carr, {J. Jeffrey} and LaMonte, {Michael J.} and Yuefang Chang and Kuller, {Lewis H.} and Rossouw, {J. E.} and S. Ludlam and Cochrane, {B. B.} and Hunt, {J. R.} and B. Lund and R. Prentice and Carr, {J. J.} and C. O'Rourke and L. Du and S. Pillsbury and C. Hightower and R. Ellison and J. Tan and S. Wassertheil-Smoller and M. Magnani and Noble, {D. H.} and T. Dellicarpini and Manson, {J. E.} and M. Bueche and McGinnis, {A. D.} and Rybicki, {F. J.} and Assaf, {A. R.} and G. Sloane and Phillips, {L. S.} and V. Butler and M. Huber and J. Vitali and J. Hsia and C. LeBrun and R. Palm and D. Embersit and E. Whitlock and K. Arnold and S. Sidney and V. Cantrell and Kotchen, {J. M.} and C. Feltz and Howard, {B. V.} and A. Thomas-Geevarghese and G. Boggs and Sweitzer, {Nancy K} and Cynthia Thomson",
year = "2017",
month = "11",
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TY - JOUR

T1 - Coronary Artery Calcification (CAC) and post-trial cardiovascular events and mortality within the Women's Health Initiative (WHI) estrogen-alone trial

AU - for the WHI and WHI-CAC Study Investigators

AU - Poornima, Indu G.

AU - Mackey, Rachel H.

AU - Allison, Matthew A.

AU - Manson, Jo Ann E.

AU - Carr, J. Jeffrey

AU - LaMonte, Michael J.

AU - Chang, Yuefang

AU - Kuller, Lewis H.

AU - Rossouw, J. E.

AU - Ludlam, S.

AU - Cochrane, B. B.

AU - Hunt, J. R.

AU - Lund, B.

AU - Prentice, R.

AU - Carr, J. J.

AU - O'Rourke, C.

AU - Du, L.

AU - Pillsbury, S.

AU - Hightower, C.

AU - Ellison, R.

AU - Tan, J.

AU - Wassertheil-Smoller, S.

AU - Magnani, M.

AU - Noble, D. H.

AU - Dellicarpini, T.

AU - Manson, J. E.

AU - Bueche, M.

AU - McGinnis, A. D.

AU - Rybicki, F. J.

AU - Assaf, A. R.

AU - Sloane, G.

AU - Phillips, L. S.

AU - Butler, V.

AU - Huber, M.

AU - Vitali, J.

AU - Hsia, J.

AU - LeBrun, C.

AU - Palm, R.

AU - Embersit, D.

AU - Whitlock, E.

AU - Arnold, K.

AU - Sidney, S.

AU - Cantrell, V.

AU - Kotchen, J. M.

AU - Feltz, C.

AU - Howard, B. V.

AU - Thomas-Geevarghese, A.

AU - Boggs, G.

AU - Sweitzer, Nancy K

AU - Thomson, Cynthia

PY - 2017/11/1

Y1 - 2017/11/1

N2 - 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 ≈8.7 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 Results--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 ageadjusted 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. 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 ≈8 years, independent of baseline randomization to conjugated equine estrogen-alone versus placebo or CVD risk factors.

AB - 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 ≈8.7 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 Results--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 ageadjusted 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. 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 ≈8 years, independent of baseline randomization to conjugated equine estrogen-alone versus placebo or CVD risk factors.

KW - Cardiovascular disease

KW - Coronary artery calcification

KW - Hormonal therapy

KW - Mortality

KW - Women

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U2 - 10.1161/JAHA.117.006887

DO - 10.1161/JAHA.117.006887

M3 - Article

C2 - 29079563

AN - SCOPUS:85034778605

VL - 6

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 11

M1 - e006887

ER -