Abstract P078: Accelerated Coronary Atherosclerosis in Postmenopausal Women with Claudication - Data from Women’s Angiographic Vitamin and Estrogen (WAVE) Trial

Abstract

Introduction: Claudication, a manifestation of peripheral artery disease (PAD), and coronary artery disease (CAD) often coexist. Both are thought to be due to atherosclerosis. The presence of PVD in patients with CAD is associated with an increased incidence of adverse cardiac events. It is not clear, however, if this increased risk is associated with a more rapid progression of coronary atherosclerosis in patients with CAD. Hypothesis: We assessed the hypothesis that the increased cardiovascular risk associated with PAD in patients with CAD is due to an increased progression of atherosclerosis. Methods: The Women’s Angiographic Vitamin and Estrogen (WAVE) trial evaluated the effects of hormone replacement therapy and antioxidant vitamins in postmenopausal women with known CAD. In WAVE, 320 women underwent careful clinical follow-up for 2.8 years and had entry and exit quantitative coronary angiograms. The degree of coronary narrowing was blindly assessed. We looked at the incidence of clinical events and changes in angiographic coronary luminal diameter between women who had claudication and those who did not. Results and Conclusion: Women with claudication were more likely to be current smokers and hypertensive. Prior to WAVE, they had had more cerebrovascular accidents. Those with claudication had more rapid progression of coronary narrowing (Table). The difference in previously diseased segments remained significant after multivariate adjustment for baseline differences and traditional cardiovascular risk factors. The presence of claudication was not associated with a risk-adjusted increase in all-cause mortality and myocardial infarction, which may be a reflection of the low power of the cohort. In conclusion, after 2.8 years of follow-up, a history of claudication was associated with a more rapid progression of coronary narrowing.