@article{daefe7afcb644cca912a762698521aff,
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 = "{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 Jelinick, {J. S.} and P. Greenland and A. Neuman and G. Carlson-Lund and Giovanazzi, {S. M.} and Stefanick, {M. L.} and S. Swope and R. Jackson and K. Toussant and Lewis, {C. E.} and P. Pierce and C. Stallings and J. Wactawski-Wende and S. Goel and R. Laughlin and J. Robbins and S. Zaragoza and D. Macias and D. Belisle and L. Nathan and B. Voigt and J. Goldin and M. Woo and Langer, {R. D.} and Allison, {M. A.} and X. Lien and Wright, {C. M.} and M. Gass and S. Sheridan and Robinson, {J. G.} and D. Feddersen and K. Kelly-Brake and J. Carroll and J. Ockene and L. Churchill and Lasser, {N. L.} and B. Miller and Maldjian, {P. D.} and J. Pierre-Louis and J. Fishman and O'Sullivan, {M. J.} and D. Fernandez and Margolis, {K. L.} and Bjerk, {C. L.} and C. Truwit and Hearity, {J. A.} and Hyslop, {W. B.} and K. Darroch and C. Murphy and G. Heiss and D. Edmundowicz and D. Ives and Johnson, {K. C.} and S. Satterfield and Connelly, {S. A.} and Jones, {E. L.} and R. Brzyski and Nashawati, {M. A.} and S. Torchia and A. Rodriguez and R. Garza and P. Nentwich and Sarto, {G. E.} and L. Broderick and Sweitzer, {N. K.} and Jacques Rossouw and Shari Ludlam and Joan McGowan and Leslie Ford and Nancy Geller and Garnet Anderson and Ross Prentice and Andrea LaCroix and Howard, {Barbara V.} and Stefanick, {Marcia L.} and Rebecca Jackson and Thomson, {Cynthia A.} and Jean Wactawski-Wende and Marian Limacher and Sally Shumaker and Robert Brunner and Margolis, {Karen L.} and Mark Espeland",
note = "Publisher Copyright: {\textcopyright} 2017 The Authors.",
year = "2017",
month = nov,
day = "1",
doi = "10.1161/JAHA.117.006887",
language = "English",
volume = "6",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
number = "11",
}