Risk factors and secondary prevention in women with heart disease: the Heart and Estrogen/progestin Replacement Study.
BACKGROUND
Risk factors for coronary heart disease events have most commonly been evaluated in healthy men.


OBJECTIVE
To assess risk factors, event rates, and use of secondary prevention treatments in women with preexisting coronary disease.


METHODS
A prospective cohort of clinical trial participants.


METHODS
20 U.S. clinical centers.


METHODS
2763 postmenopausal women with known coronary disease in the Heart and Estrogen/progestin Replacement Study (HERS).


METHODS
Myocardial infarction or death from coronary heart disease.


RESULTS
On multivariable analysis, the researchers found 11 risk factors: 6 noted by history (nonwhite ethnicity, lack of exercise, treated diabetes, angina, congestive heart failure, and more than one previous myocardial infarction) and 5 that were measured (blood pressure, low-density lipoprotein cholesterol level, high-density lipoprotein cholesterol level, lipoprotein(a) level, and creatinine clearance). The annual rate of coronary events was 1.3% (95% CI, 0.7% to 2.5%) in women with no risk factors and 8.7% (CI, 7.1% to 10.8%) in women with five or more risk factors (a sixfold increase). At entry into HERS, 83% of participants were receiving aspirin or other antiplatelet agents, 33% were receiving beta-blockers, 18% were receiving angiotensin-converting enzyme inhibitors, and 53% were receiving lipid-lowering drugs. Women with more risk factors were less likely to be taking aspirin (P < 0.001) and lipid-lowering drugs (P = 0.006).


CONCLUSIONS
Women with coronary disease are at high risk for myocardial infarction or death from coronary heart disease even in the absence of other risk factors, and their risk increases up to sixfold when many risk factors are present. Established drugs for secondary prevention, including aspirin, beta-blockers, and lipid-lowering agents, are underused in these women, especially those at highest risk.
Vittinghoff
Eric
E
University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, 74 New Montgomery, Suite 600, San Francisco, California 94105, USA.
Shlipak
Michael G
MG
Varosy
Paul D
PD
Furberg
Curt D
CD
Ireland
Christine C
CC
Khan
Steven S
SS
Blumenthal
Roger
R
Barrett-Connor
Elizabeth
E
Hulley
Stephen
S
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000150:complications* / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017698:Postmenopause; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin