Title

Cardiovascular risk in women with non-specific chest pain (from the Women's Health Initiative Hormone Trials)

UMMS Affiliation

Department of Medicine, Division of Preventive and Behavioral Medicine

Date

9-15-2008

Document Type

Article

Subjects

Aged; Cardiovascular Diseases; Chest Pain; Contraceptive Agents, Female; Diabetes Mellitus; *Estrogen Replacement Therapy; Estrogens; Estrogens, Conjugated (USP); Female; Hospitalization; Humans; Hypertension; Medroxyprogesterone Acetate; Middle Aged; Myocardial Revascularization; Proportional Hazards Models; Prospective Studies; Randomized Controlled Trials as Topic; Risk

Disciplines

Life Sciences | Medicine and Health Sciences | Women's Studies

Abstract

Women discharged with diagnoses of nonspecific chest pain (NSCP) may be at increased risk for subsequent coronary artery disease (CAD) events. The influence of hormone therapy on NSCP is unknown. The Women's Health Initiative (WHI) enrolled postmenopausal women aged 50 to 79 years. The duration of follow-up was 7.1 years in the WHI Estrogen-Alone trial (E-Alone) and 5.6 years in the WHI Estrogen Plus Progestin trial (E+P). After excluding women with previous cardiovascular disease, 9,427 women in E-Alone and 15,105 women in E+P were included in this analysis. NSCP, defined as having a primary hospital discharge diagnosis of NSCP by International Classification of Diseases, Ninth Revision, code, was reported in 322 women in E-Alone and 249 in E+P. Risks for subsequent CAD events were estimated using intent-to-treat Cox proportional-hazards models stratified by clinic and adjusted for age and other risk factors. In the fully adjusted models of the combined trials, women with NSCP had a twofold greater risk for subsequent nonfatal CAD events, including nonfatal myocardial infarction (2.3% vs 1.7%, hazard ratio [HR] 2.10, 95% confidence interval [CI] 1.11 to 3.98), revascularization (3.5% vs 2.6%, HR 1.99, 95% CI 1.20 to 3.30), and hospitalized angina (3.7% vs 2.3%, HR 2.39, 95% CI 1.46 to 3.92). Hormone therapy did not appear to have a significant effect on either the incidence of NSCP hospitalizations (E-Alone: HR 1.04, 95% CI 0.81 to 1.32; E+P: HR 0.78, 95% CI 0.59 to 1.02) or the risk for a subsequent CAD event. In conclusion, a hospitalization for NSCP doubles the risk for a subsequent CAD event in postmenopausal women over the next 5 to 7 years and identifies them as candidates for aggressive risk factor treatment.

Rights and Permissions

Citation: Am J Cardiol. 2008 Sep 15;102(6):693-9. Epub 2008 Jul 2. Link to article on publisher's site

Related Resources

Link to Article in PubMed

PubMed ID

18773990