780-4 ST Segment Depression Risk, Menopause, Hysterectomy and Exogenous Estrogen in Asymptomatic Women

Abstract

In a 1993 follow-up survey, the Women Take Heart Project assessed 1992 menopausal status, including hysterectomy, and validated exogenous estrogen use (both estrogen replacement therapy and birth control pills) in 5932 women (W) who were examined and treadmill stress tested during 1992. 5449 W provided complete data for these analyses. Using logistic regression to estimate the relative likelihood of significant ST segment depression (1 mm at 80 msec) while taking into account age, body mass index (kg/m 2 ), cholesterol, resting heart rate, supine systolic blood pressure (SBP, mmHg). educational attainment and weekly aerobic exercise frequency as continuous variables, and employment, black race and smoking as categorical factors, the effects of estrogen and menopausal status (pre-menopausal: Pre, menopausallpost: M, and hysterectomy: Hyst) were examined. Hyst-W were younger than M-W at examination (mean age 56.4 vs. 59.3). and their mean age at hysterectomy was younger than either the mean age of menopause onset or completion that M-W reported (41 vs. 47 and 50 years old). The overall fit of the model was highly significant (model chi-square with 14 df = 211.67, p < 0.0001). Variable B S.E. df Sig Odds Ratio Age (each addtl yr) 0.009 0.0047 1 0.0493 1.01 Estrogen Use 0.372 0.0775 1 0.0000 1.45 Reprod Status Overall 3 0.0048 (Pre-menopause: reference category) 1.00 Menopausal/post 0.187 0.0582 1 0.0013 1.21 Late hyst (<35 yrs) 0.114 0.0636 1 0.0725 1.12 Early hyst –0.254 0.0924 1 0.0059 0.78 Conclusions: 1) Post-menopausal status, independent of aging, appears to increase women's cardiovascular disease risk. 2) Exogenous estrogen appears to increase women's likelihood of responding to exercise stress testing with ST segment depression.