Top

BMC Cardiovascular Disorders

Published in:

Open Access 01-12-2004 | Research article

Progression of coronary calcification in healthy postmenopausal women

Authors: Judith Hsia, Afifa Klouj, Anjana Prasad, Jeremy Burt, Lucile L Adams-Campbell, Barbara V Howard

Published in: BMC Cardiovascular Disorders | Issue 1/2004

Abstract

Background

Coronary artery calcium score incrementally improves coronary risk prediction beyond that provided by conventional risk factors. Limited information is available regarding rates of progression of coronary calcification in women, particularly those with baseline scores above zero. Further, determinants of progression of coronary artery calcification in women are not well understood. This study prospectively evaluated rates and determinants of progression of coronary artery calcium score in a group of healthy postmenopausal women.

Methods

We determined coronary calcium score by computed tomography and recorded demographic, lifestyle and health characteristics of 914 postmenopausal women, a subset of those enrolled in the Women's Health Initiative Observational Study. The 305 women with calcium score ≥10 Agatston units at baseline were invited for repeat scan. This analysis includes the 94 women who underwent second scans.

Results

Mean age of study participants was 65 ± 9 years (mean ± SD), body mass index was 26.1 ± 6.1 kg/m², and baseline calcium score was 162 ± 220 Agatston units. Mean interval between scans was 3.3 ± 0.7 years. A wide range of changes in coronary calcium score was observed, from -53 to +452 Agatston units/year. Women with lower scores at baseline had smaller annual increases in absolute calcium score. Coronary calcium scores increased 11, 31 and 79 Agatston units/year among women with baseline calcium score in the lowest, middle and highest tertiles. In multivariate analysis, age was not an independent predictor of absolute change in coronary calcium score. Hydroxymethylglutaryl coenzyme A reductase inhibitor (statin) use at baseline was a negative predictor (p = 0.015), whereas baseline calcium score was a strong, positive predictor (p < 0.0001) of progression of coronary calcification.

Conclusion

Among postmenopausal women with coronary calcium score ≥ 10 Agatston units, rates of change of coronary calcium score varied widely. In multivariate analysis, statin use was a negative independent determinant, whereas baseline calcium score was a strong positive predictor of annual change in coronary calcium score.

Pletcher MJ, Tice JA, Pignone M, Browner WS: Using the coronary artery calcium score to predict coronary heart disease events: a systematic review and meta-analysis. Arch Intern Med. 2004, 164: 1285-92. 10.1001/archinte.164.12.1285.CrossRefPubMed

Kondos GT, Hoff JA, Sevrukov A, Daviglus ML, Garside DB, Devries SS, Chomka EV, Liu K: Electron-Beam Tomography Coronary Artery Calcium and Cardiac Events. A 37-month Follow-Up of 5635 Initially Asymptomatic Low- to Intermediate-Risk Adults. Circulation. 2003, 107: 2571-6. 10.1161/01.CIR.0000068341.61180.55.CrossRefPubMed

Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC: Coronary Artery Calcium Score Combined With Framingham Score for Risk Prediction in Asymptomatic Individuals. JAMA. 2004, 291: 210-5. 10.1001/jama.291.2.210.CrossRefPubMed

Schmermund A, Erbel R, Silber S, for the MUNICH Registry Study Group: Age and Gender Distribution of Coronary Artery Calcium Measured by Four-Slice Computed Tomography in 2,030 Persons With no Symptoms of Coronary Artery Disease. Am J Cardiol. 2002, 90: 168-73. 10.1016/S0002-9149(02)02445-1.CrossRefPubMed

Mahoney LT, Burns TL, Stanford W, Thompson BH, Witt JD, Rost CA, Lauer RM: Coronary Risk Factors Measured in Childhood and Young Adult Life Are Associated With Coronary Artery Calcification in Young Adults: The Muscatine Study. JACC. 1996, 27: 277-84.CrossRefPubMed

Shemesh J, Apter S, Stolero D, Itzchak Y, Motro M: Annual Progression of Coronary Artery Calcium by Spiral Computed Tomography in Hypertensive Patients Without Myocardial Ischemia But With Prominent Atherosclerotic Risk Factors, in Patients With Previous Angina Pectoris or Healed Acute Myocardial Infarction, and in Patients With Coronary Events During Follow-Up. Am J Cardiol. 2001, 87: 1395-7. 10.1016/S0002-9149(01)01561-2.CrossRefPubMed

Raggi P, Callister TQ, Shaw LJ: Progression of Coronary Artery Calcium and Risk of First Myocardial Infarction in Patients Receiving Cholesterol-Lowering Therapy. Arterioscler Thromb Vasc Biol. 2004, 24: 1272-7. 10.1161/01.ATV.0000112102.28859.39.CrossRefPubMed

Tani T, Yamakami S, Matsushita T, Okamoto M, Toyama J, Fukutomi T, Itoh M: Comparison of Coronary Artery Calcium Progression of Electron Beam Computed Tomography and Angiographically Defined Progression. Am J Cardiol. 2003, 91: 865-7. 10.1016/S0002-9149(03)00021-3.CrossRefPubMed

Budoff MJ, Lane KL, Bakhsheshi H, Mao S, Grassmann BO, Friedman BC, Brundage BH: Rates of progression of coronary calcium by electron beam tomography. Am J Cardiol. 2000, 86: 8-11. 10.1016/S0002-9149(00)00820-1.CrossRefPubMed

10.

Sutton-Tyrrell K, Kuller LH, Edmundowicz D, Feldman A, Holubkov R, Givens L, Matthews KA: Usefulness of Electron Beam Tomography to Detect Progression of Coronary and Aortic Calcium in Middle-Aged Women. Am J Cardiol. 2001, 87: 560-4. 10.1016/S0002-9149(00)01431-4.CrossRefPubMed

11.

Schmermund A, Baumgart D, Mohlenkamp S, Kriener P, Pump H, Gronemeyer D, Seibel R, Erbel R: Natural history and topographic pattern of progression of coronary calcification in symptomatic patients: An electron-beam CT study. Arterioscler Thromb Vasc Biol. 2001, 21: 421-6.CrossRefPubMed

12.

Callister TQ, Raggi P, Cooil B, Lippolis NJ, Russo DJ: Effect of HMG-CoA Reductase Inhibitors on Coronary Artery Disease as Assessed by Electron-Beam Computed Tomography. N Engl J Med. 1998, 339: 1972-8. 10.1056/NEJM199812313392703.CrossRefPubMed

13.

Achenbach S, Ropers D, Pohle K, Leber A, Thilo C, Knez A, Menendez T, Maeffert R, Kusus M, Regenfus M, Bickel A, Haberl R, Steinbeck G, Moshage W, Daniel WG: Influence of Lipid-Lowering Therapy on the Progression of Coronary Artery Calcification. Circulation. 2002, 106: 1077-82. 10.1161/01.CIR.0000027567.49283.FF.CrossRefPubMed

14.

The Women's Health Initiative Study Group: Design of the Women's Health Initiative Clinical Trial and Observational Study. Control Clin Trials. 1998, 19: 61-109. 10.1016/S0197-2456(97)00078-0.CrossRef

15.

Henderson MM, Kushi LH, Thompson DJ: Feasibility of a randomized trial of a low-fat diet for the prevention of breast cancer: Dietary compliance in the Women's Health Trial Vanguard Study. Prev Med. 1990, 19: 115-33. 10.1016/0091-7435(90)90014-B.CrossRefPubMed

16.

Patterson RE, Kristal AR, Tinker LF: Measurement Characteristics of the Women's Health Initiative Food Frequency Questionnaire. Ann Epidemiol. 1999, 9: 178-87. 10.1016/S1047-2797(98)00055-6.CrossRefPubMed

17.

Manson JE, Greenland P, LaCroix AZ, Stefanick ML, Mouton CP, Oberman A, Perri MG, Sheps D, Pettinger MB, Siscovick DS: Walking compared with vigorous exercise for the prevention of cardiovascular events in women. New Engl J Med. 2002, 347: 716-25. 10.1056/NEJMoa021067.CrossRefPubMed

18.

Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R: Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990, 15: 827-32.CrossRefPubMed

19.

Achenbach S, Nomayo A, Couturier G, Ropers D, Pohle K, Schlundt C, Schmermund A, Matarazzo RJ, Hoffman U, Daniel WG, Killip T: Relation Between Coronary Calcium and 10-Year Risk Scores in Primary Prevention Patients. Am J Cardiol. 2003, 92: 1471-5. 10.1016/j.amjcard.2003.08.064.CrossRefPubMed

20.

Schisterman EF, Gallagher AM, Bairey Merz CN, Whitcomb BW, Faraggi D, Moysich KB, Lewin H: The association of hormone replacement therapy and coronary calcium as determined by electron beam tomography. J Womens Health Gend Based Med. 2002, 11: 631-8. 10.1089/152460902760360577.CrossRefPubMed

21.

Chironi G, Simon A, Denarie N, Vedie B, Sene V, Megnien JL, Levenson J: Determinants of progression of coronary artery calcifications in asymptomatic men at high cardiovascular risk. Angiology. 2002, 53: 677-83.CrossRefPubMed

22.

Callister TQ, Cooil B, Raya SP, Lippolis NJ, Russo DJ, Raggi P: Coronary artery disease: improved reproducibility of calcium scoring with an electron-beam CT volumetric method. Radiology. 1998, 208: 807-14.CrossRefPubMed

23.

Nasir K, Raggi P, Rumberger JA, Braunstein JB, Post WS, Budoff MJ, Blumenthal RS: Coronary Artery Calcium Volume Scores on Electron Beam Tomography in 12,936 Asymptomatic Adults. Am J Cardiol. 2004, 93: 1146-9. 10.1016/j.amjcard.2004.01.043.CrossRefPubMed

24.

Raggi P, Shaw LJ, Berman DS, Callister TQ: Gender-based differences in the prognostic value of coronary calcification. J Womens Health (Larchmt). 2004, 13: 273-83. 10.1089/154099904323016437.CrossRef

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2261/4/21/prepub

Title: Progression of coronary calcification in healthy postmenopausal women
Authors: Judith Hsia
Afifa Klouj
Anjana Prasad
Jeremy Burt
Lucile L Adams-Campbell
Barbara V Howard
Publication date: 01-12-2004
Publisher: BioMed Central
Published in: BMC Cardiovascular Disorders / Issue 1/2004
Electronic ISSN: 1471-2261
DOI: https://doi.org/10.1186/1471-2261-4-21

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Progression of coronary calcification in healthy postmenopausal women

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2004

The influence of statins on the free intracellular calcium concentration in human umbilical vein endothelial cells

Outcome after acute myocardial infarction: a comparison of patients seen by cardiologists and general physicians

Single nucleotide polymorphisms in the apolipoprotein B and low density lipoprotein receptor genes affect response to antihypertensive treatment

Hospitalization for heart disease, stroke, and diabetes mellitus among Indian-born persons: a small area analysis

Signaling of angiotensin II-induced vascular protein synthesis in conduit and resistance arteries in vivo

A randomised controlled trial and cost effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in the over 65s: (SAFE) [ISRCTN19633732]