Abstract
BackgroundCoronary 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.MethodsWe 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.ResultsMean 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.ConclusionAmong 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.
Highlights
Coronary artery calcium score incrementally improves coronary risk prediction beyond that provided by conventional risk factors
Age is by far the most potent determinant of calcium score [4], conventional risk factors been associated with the extent of coronary calcification [4,5]
Calcium scores differ in men and women [4], but progression of coronary calcification has not been reported by gender, except for the Healthy Women Study, which only included women [10]
Summary
Coronary artery calcium score incrementally improves coronary risk prediction beyond that provided by conventional risk factors. Score ≥10 Agatston units were mailed a letter inviting them to have a second scan; African-American women received two mailings because of a historically lower response rate. This analysis includes the 94 women with serial scans, which were performed a mean of 3.3 ± 0.7 years after the baseline study. The rate of progression of coronary calcification appears to further stratify risk [6,7], but reports have been limited by sample size [8], retrospective design [6,8,9], inclusion of individuals with baseline calcium scores of zero [9,10] and limited interval between tomographic scans [8,10,11]. Among the 28 women with measurable coronary calcium at baseline, mean change was 11 Agatston units for women with baseline calcium score 1–99, and 72 Agatston units for the 9 women with baseline calcium score ≥100
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