© 1999 American Heart Association, Inc.
Atherosclerosis and Lipoproteins |
Coronary and Aortic Calcification Among Women 8 Years After Menopause and Their Premenopausal Risk Factors
The Healthy Women Study
From the Graduate School of Public Health, Department of Epidemiology (L.H.K., K.S.-T.), the Cardiovascular Institute of the UPMC Health System (K.A.M.), and the Division of Cardiology, School of Medicine (D.E.), University of Pittsburgh, Pittsburgh, Pa.
Correspondence to Lewis H. Kuller, MD, DrPH, University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, 130 De Soto St, Room A527, Pittsburgh, PA 15261. E-mail kuller+{at}pitt.edu
Abstract—In the Healthy Women
Study, the relationship between cardiovascular risk
factors measured premenopausally at age 48, use of hormone therapy, and
coronary and aortic calcification at age 58 were evaluated
among 169 women. Approximately 63% of women had no coronary
calcification, but only 29% had no aortic calcification.
Coronary calcification and aortic calcification were positively
correlated with each other. There was a very strong association between
low density lipoprotein cholesterol (LDL-C) level and
coronary calcification. Among women with premenopausal levels
of LDL-C <100 mg/dL, only 9% had a coronary calcium score
101 compared with 30% of women with an LDL-C >160 mg/dL. Only 5%
of women with a high density lipoprotein cholesterol
(HDL-C) level >60 mg/dL had high coronary scores. The level of
HDL2-C was especially strongly inversely related to
coronary calcium scores. Cigarette smoking was a very important
determinant of both high aortic and high coronary calcium
scores. Other risk factors associated with greater coronary
calcium were higher systolic blood pressure,
triglycerides levels, and blood glucose. Use of hormone
replacement therapy was associated with less coronary calcium
(NS). For both hormone replacement therapy users and nonusers,
the levels of LDL-C and HDL-C measured premenopausally were predictors
of coronary and aortic calcium scores. Thus, risk factors
evaluated premenopausally are powerful predictors of coronary
and aortic calcification, a marker of atherosclerosis,
measured 8 years after menopause, 11 years later in these women.
Key Words: coronary artery disease • coronary calcification • lipids • smoking • hormone replacement therapy
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