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Open Access Research article

Progression of coronary calcification in healthy postmenopausal women

Judith Hsia1*, Afifa Klouj2, Anjana Prasad1, Jeremy Burt1, Lucile L Adams-Campbell3 and Barbara V Howard4

Author Affiliations

1 Department of Medicine, The George Washington University, Washington, DC 20037, USA

2 Biostatistics Center Medical Center Unit, The George Washington University, Washington, DC 20037, USA

3 Howard University Cancer Center, Washington, DC 20060, USA

4 Medstar Research Institute, Hyattsville, MD 20783 USA

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BMC Cardiovascular Disorders 2004, 4:21  doi:10.1186/1471-2261-4-21

Published: 1 December 2004

Abstract

Background

Coronary 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.

Methods

We 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.

Results

Mean 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.

Conclusion

Among 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.