Effect of Stress Echocardiography Testing on Changes in Cardiovascular Risk Behaviors in Postmenopausal Women: A Prospective Survey Study

Abstract

We evaluated the impact of contrast stress echocardiography (CSE) testing results on cardiovascular (CV) risk behaviors in postmenopausal women presenting with chest pain symptoms. This was a substudy of the Stress Echocardiography in Menopausal Women at Risk for Coronary Artery Disease (SMART) trial. From 2004 to 2007, 366 women (mean age 54.4 ± 5.5 years, range 40-65; body mass index (BMI) 31.4 ± 6.68; Caucasian in 95%) completed CSE and were invited to participate in the Women's Heart Clinic Risk Assessment Questionnaire (WHCRAQ survey) at the time of CSE and after 2 years. Of the 366, 203 (55%) postmenopausal women completed both the baseline and 2-year follow-up surveys (age 61 ± 5 years; Framingham risk score 6 ± 4%, 81% treadmill CSE, 19% dobutamine CSE). WHCRAQ assessed medical history, hormone therapy (HT), and CV risk behaviors (cigarette smoking history, including current smoking and mean cigarettes smoked per day; physical activity or exercise, including mean exercise minutes per week; and dietary fat intake, alcohol intake, and mean alcohol drinks per week). Abnormal CSE was defined as a new or worsening stress wall motion abnormality. Post-CSE changes in CV risk behaviors were determined by comparing baseline versus 2-year data. Of the 203 women who completed the survey at baseline and 2-year CSE, 29 were excluded to avoid confounding effect (coronary angiography [CA] was performed during follow-up). Of 174 women (55% hypertensive, 10% diabetic, 76% hyperlipidemic, and 25% on HT), CSE was abnormal in 10%. Baseline characteristics were not significantly different in normal versus abnormal CSE, apart from diabetes (8% vs. 24%, p=0.04). Slightly more women with normal CSE were taking HT than not (27% vs. 12%, p=0.19). CV risk behaviors that were different in normal versus abnormal CSE included current smoking, alcohol drinks per week, and higher fat diet (8% vs. 24%, p=0.03; 2.5 ± 3.5 vs. 1.94±5.2, p=0.031; and 92% vs. 76%, p=0.03, respectively). Cigarette smoking decreased (mean difference of -1.5 cigarettes per day, p=0.014) in the abnormal-CSE group, whereas number of alcohol drinks per week increased (mean difference +0.38, p=0.009) in the normal-CSE group. We observed an association of lifestyle changes with CSE test results in postmenopausal women.