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Vasomotor symptoms and coronary artery calcium in postmenopausal women

Allison, Matthew A. MD, MPH1; Manson, JoAnn E. MD2; Aragaki, Aaron MS3; Langer, Robert D. MD4; Rossouw, Jacques MD5; Curb, David MD6; Martin, Lisa W. MD7; Phillips, Lawrence MD8; Stefanick, Marcia L. PhD9; Cochrane, Barbara B. PhD10; Sarto, Gloria MD11; Barnhart, Janice MD12; O'Sullivan, Mary Jo MD13; Johnson, Karen C. MD14; Gass, Margery MD15; Trevisan, Maurizio MD16; Woods, Nancy F. PhD10

doi: 10.1097/gme.0b013e3181e664dc

Objective: We assessed whether vasomotor symptoms (VMS) are associated with coronary artery calcium (CAC) and how hormone therapy (HT) may influence this association.

Methods: Participants were a subset of women aged 50 to 59 years with a history of hysterectomy who were enrolled in the Women's Health Initiative (WHI) estrogen-alone clinical trial and underwent a CT scan of the chest at the end of the trial to determine CAC. Participants provided information about VMS (hot flashes and/or night sweats), as well as HT use, on self-administered questionnaires at trial baseline.

Results: The sample consisted of 918 women with a mean (SD) age of 55.1 (2.8) years at WHI randomization and 64.8 (2.9) years at CAC ascertainment. The prevalence of a CAC score higher than 0 was 46%, whereas the prevalence of a CAC score of 10 or higher and higher than 100 was 39% and 19%, respectively. At randomization, 77% reported a history of any VMS at any time before or at enrollment in the WHI, whereas 20% reported any VMS present only at enrollment. Compared with those without a history of any VMS and after adjustment for potential confounders, a history of any VMS at any time up to and including WHI enrollment was associated with significantly reduced odds for CAC higher than 0 (odds ratio, 0.66; 95% CI, 0.45-0.98). Moreover, as duration of HT increased, the inverse association between any VMS and CAC moved toward the null.

Conclusions: A history of any VMS was significantly associated with reduced odds for CAC independent of traditional cardiovascular disease risk factors and other relevant covariates. This association seems to be influenced by duration of HT.

History of any vasomotor symptoms was significantly associated with reduced odds for coronary artery calcium independent of traditional cardiovascular disease risk factors and other relevant covariates. This association appears to be influenced by duration of hormone therapy.

Received February 3, 2010; revised and accepted March 29, 2010.

From the 1University of California San Diego, La Jolla, CA; 2Brigham and Women's Hospital, Harvard Medical School, Boston, MA; 3Fred Hutchinson Cancer Research Center, Seattle, WA; 4Jackson Hole Center for Preventive Medicine, Jackson, WY; 5National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD; 6University of Hawaii, Honolulu, HI; 7George Washington University, Washington, DC; 8Emory University, Atlanta, GA; 9Stanford University, Stanford, CA; 10University of Washington, Seattle, WA; 11University of Wisconsin, Madison, WI; 12Albert Einstein University, Bronx, NY; 13University of Miami, Miami, FL; 14University of Tennessee Health Science Center,Memphis, TN; 15University of Cincinnati, Cincinnati, OH; and 16Health Sciences System of the Nevada System of Higher Education, LasVegas, NV.

Funding/support: Support for this research was provided by contracts withthe National Institutes of Health and a grant from theAmerican HeartAssociation. The National Heart, Lung, and Blood Institute and US Department of Health and Human Services funds the Women's Health Initiative (WHI) program and provided support for the WHI Coronary Artery Calcium Study ancillary study. Wyeth provided study pills (active and placebo) for the WHI Conjugated Equine Estrogens trial but had no other role in the study. This work was also supported in part by a grant from the American Heart Association (M.A. Allison). The authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Matthew A. Allison, MD, MPH, 9500 Gilman Drive, Mailcode 0965, La Jolla, CA 92093-0965. E-mail:

©2010The North American Menopause Society