Estrogen therapy and coronary-artery calcification.
BACKGROUND
Calcified plaque in the coronary arteries is a marker for atheromatous-plaque burden and is predictive of future risk of cardiovascular events. We examined the relationship between estrogen therapy and coronary-artery calcium in the context of a randomized clinical trial.


METHODS
In our ancillary substudy of the Women's Health Initiative trial of conjugated equine estrogens (0.625 mg per day) as compared with placebo in women who had undergone hysterectomy, we performed computed tomography of the heart in 1064 women aged 50 to 59 years at randomization. Imaging was conducted at 28 of 40 centers after a mean of 7.4 years of treatment and 1.3 years after the trial was completed (8.7 years after randomization). Coronary-artery calcium (or Agatston) scores were measured at a central reading center without knowledge of randomization status.


RESULTS
The mean coronary-artery calcium score after trial completion was lower among women receiving estrogen (83.1) than among those receiving placebo (123.1) (P=0.02 by rank test). After adjustment for coronary risk factors, the multivariate odds ratios for coronary-artery calcium scores of more than 0, 10 or more, and 100 or more in the group receiving estrogen as compared with placebo were 0.78 (95% confidence interval, 0.58 to 1.04), 0.74 (0.55 to 0.99), and 0.69 (0.48 to 0.98), respectively. The corresponding odds ratios among women with at least 80% adherence to the study estrogen or placebo were 0.64 (P=0.01), 0.55 (P<0.001), and 0.46 (P=0.001). For coronary-artery calcium scores of more than 300 (vs. <10), the multivariate odds ratio was 0.58 (P=0.03) in an intention-to-treat analysis and 0.39 (P=0.004) among women with at least 80% adherence.


CONCLUSIONS
Among women 50 to 59 years old at enrollment, the calcified-plaque burden in the coronary arteries after trial completion was lower in women assigned to estrogen than in those assigned to placebo. However, estrogen has complex biologic effects and may influence the risk of cardiovascular events and other outcomes through multiple pathways. (ClinicalTrials.gov number, NCT00000611.)
Manson
Joann E
JE
Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA. jmanson@rics.bwh.harvard.edu
Allison
Matthew A
MA
Rossouw
Jacques E
JE
Carr
J Jeffrey
JJ
Langer
Robert D
RD
Hsia
Judith
J
Kuller
Lewis H
LH
Cochrane
Barbara B
BB
Hunt
Julie R
JR
Ludlam
Shari E
SE
Pettinger
Mary B
MB
Gass
Margery
M
Margolis
Karen L
KL
Nathan
Lauren
L
Ockene
Judith K
JK
Prentice
Ross L
RL
Robbins
John
J
Stefanick
Marcia L
ML
D002114:Calcinosis / Q000000981:diagnostic imaging / Q000517:prevention & control*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000517:prevention & control*; D015914:Estrogen Replacement Therapy; D004966:Estrogens, Conjugated (USP) / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017698:Postmenopause; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D004966:Estrogens, Conjugated (USP)