title: Inflammatory/hemostatic biomarkers and coronary artery calcification in midlife women of African-American and White race/ethnicity: the Study of Women's Health Across the Nation (SWAN) heart study.
abstract: Inflammatory/hemostatic biomarkers are associated with coronary heart disease events, but relationships in asymptomatic midlife women are uncertain. We evaluated separately whether high-sensitivity C-reactive protein (hsCRP), fibrinogen, plasminogen-activator inhibitor 1, tissue plasminogen activator antigen, and circulating factor VII (factor VIIc) were associated with coronary artery calcification (CAC) in healthy midlife women.
  
  
  
  A cross-sectional study was performed of participants from the Study of Women's Health Across the Nation. Logistic and Tobit regression was used to assess associations between log-transformed biomarkers, and CAC presence (CAC > 0) and extent. Effect modification by race/ethnicity was evaluated.
  
  
  
  The study included 372 women (mean age 51.3 y; 35.2% African-American). All biomarkers were positively associated with CAC presence and extent (P < 0.001 for all), adjusting for Framingham risk score, site, race/ethnicity, menopause status, income, and education. Additional adjustment for body mass index explained all associations except for factor VIIc, which remained associated with CAC extent only (P = 0.02). Final adjustment for insulin resistance, family history of cardiovascular disease, and cardiovascular medication use produced similar results. Associations between hsCRP, and CAC presence and extent were modified by race/ethnicity (P < 0.05). Log(hsCRP) was positively associated with CAC presence (odds ratio 3.25; 95% CI, 1.53-6.90; P = 0.002; per 1 log unit increase) and CAC extent (β = 19.66; SE = 7.67; P = 0.01; per 1 log unit increase) in African-Americans only.
  
  
  
  Inflammatory/hemostatic biomarkers were associated with CAC through obesity, except for factor VIIc. Among African-American women only, hsCRP was independently associated with CAC, suggesting that hsCRP may have a role in coronary heart disease prevention in African-American midlife women.
authors.affiliation: 1University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 2Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Norman C
authors.initials: NC
authors.lastname: Wang
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
authors.forename: Emma J M
authors.initials: EJ
authors.lastname: Barinas-Mitchell
authors.forename: Chung-Chou H
authors.initials: CC
authors.lastname: Chang
authors.forename: Samar R
authors.initials: SR
authors.lastname: El Khoudary
mesh_terms: D001741:Black or African American; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D003324:Coronary Artery Disease / Q000097:blood* / Q000208:ethnology; D003430:Cross-Sectional Studies; D005167:Factor VII / Q000032:analysis; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006487:Hemostasis / Q000502:physiology; D006801:Humans; D007249:Inflammation / Q000097:blood*; D008875:Middle Aged; D009765:Obesity / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D010959:Tissue Plasminogen Activator / Q000097:blood; D061205:Vascular Calcification / Q000097:blood* / Q000208:ethnology; D044465:White People; D016387:Women's Health
chemical_list: D015415:Biomarkers; D017395:Plasminogen Activator Inhibitor 1; D005167:Factor VII; D005340:Fibrinogen; D002097:C-Reactive Protein; D010959:Tissue Plasminogen Activator