UMMS Affiliation

UMass Worcester Prevention Research Center; Department of Medicine, Division of Preventive and Behavioral Medicine

Publication Date


Document Type



Behavioral Medicine | Behavior and Behavior Mechanisms | Cardiology | Cardiovascular Diseases | Community Health | Community Health and Preventive Medicine | Preventive Medicine | Women's Health


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

CLINICAL TRIAL REGISTRATION: URL: Unique identifier: NCT00000611.


cardiovascular disease, coronary artery calcification, hormonal therapy, mortality, women

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© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

DOI of Published Version



J Am Heart Assoc. 2017 Oct 27;6(11). pii: e006887. doi: 10.1161/JAHA.117.006887. Link to article on publisher's site

Journal/Book/Conference Title

Journal of the American Heart Association


Judith Ockene is a Women’s Health Initiative Coronary-Artery Calcium Study Investigator.

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Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.