Premenopausal risk factors for coronary and aortic calcification: A 20-year follow-up in the healthy women study

Objective It is important to understand the early development of subclinical cardiovascular disease (CVD) in women to prevent costly morbidity and mortality associated with CVD events. Methods 363 Women enrolled in the Healthy Women Study, Allegheny County, PA, had electron beam tomography measures of coronary (CaC) and aortic (AC) calcification on average 14.6 years after study entry in 1983; 267 had a second EBT 6.4 years later, by 2006. Risk factors were assessed when women were premenopausal and 5 years after the menopause. Results Step-wise logistic regression analyses showed that the independent premenopausal predictors of CaC ≥ 100 14.6 years later were low-density lipoprotein cholesterol, OR = 1.15 (1.03–1.29 for 10 mg/dl) and current smoker, OR = 2.72, 1.29–5.71. The same premenopausal risk factors were predictors of AC ≥ 500, in addition to premenopausal systolic blood pressure (SBP). Similar results were obtained for predicting calcification 20.6 years later. Postmenopausal risk factors measured 5 years prior to the initial scans were unrelated to CaC and AC, after the significant premenopausal risk factors were taken into account, except for postmenopausal SBP being related to AC. Conclusion Premenopausal risk factors are strong predictors of postmenopausal CaC and AC. Clinical trials should test if reduction of premenopausal levels of risk factors reduces the risk of early calcification.