CLINICAL RESEARCH
Hypertension, Menopause, and Coronary Artery Disease Risk in the Women’s Ischemia Syndrome Evaluation (WISE) Study
Gretchen L. Gierach, MPH*,
B. Delia Johnson, PhD*,
C. Noel Bairey Merz, MD, FACC ,*,
Sheryl F. Kelsey, PhD*,
Vera Bittner, MD, FACC ,
Marian B. Olson, MS*,
Leslee J. Shaw, PhD ,
Sunil Mankad, MD, FACC||,
Carl J. Pepine, MD, FACC¶,
Steven E. Reis, MD, FACC#,
William J. Rogers, MD, FACC,
Barry L. Sharaf, MD, FACC**,
George Sopko, MD for the WISE Study Group
* Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, and Department of Medicine, University of California School of Medicine, Los Angeles, California
Division of Cardiology, Department of Medicine, University of Alabama, Birmingham, Alabama
Atlanta Cardiovascular Research Institute, Atlanta, Georgia
|| Division of Cardiology, Department of Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania
¶ Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida
# Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
** Division of Cardiology, Rhode Island Hospital, Providence, Rhode Island
Division of Cardiology, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
Manuscript received January 6, 2005;
accepted February 8, 2005.
* Reprint requests and correspondence: Dr. C. Noel Bairey Merz, c/o WISE Coordinating Center, 127 Parran Hall, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, Pennsylvania 15261 (Email: noel.baireymerz{at}cshs.org).
OBJECTIVES: We evaluated whether the relationship between hypertension, other cardiac risk factors, and coronary artery disease (CAD) is modulated by menopausal status and/or age.
BACKGROUND: The relative contribution of age versus menopausal status in the development of CAD in women remains unclear.
METHODS: We compared systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and traditional cardiac risk factors for CAD in premenopausal (n = 123) and postmenopausal (n = 482) women undergoing coronary angiography for suspected ischemia. To assess the relative contribution of age versus menopausal status, we fit a hypertension-menopausal status interaction term and adjusted for age.
RESULTS: There were similar relationships with regard to traditional coronary risk factors and angiographic CAD in premenopausal versus postmenopausal women, with few exceptions. Twenty percent of premenopausal women had angiographic CAD versus 31% of postmenopausal women (p = 0.02). Premenopausal women had lower mean (standard deviation) SBP (132 [25] vs. 139 [20] mm Hg; p < 0.0001) and lower PP (54 [18] vs. 62 [18] mm Hg; p < 0.0001) compared to postmenopausal women; however, multivariable analyses revealed that SBP was a risk factor for CAD in premenopausal (p = 0.002) but not postmenopausal women (p = 0.13), and regression slopes were significantly different (p = 0.04). This interaction effect remained after age adjustment, suggesting independent risk contribution from both age and menopausal status. A similar slope difference was observed for PP (p = 0.03) but not for DBP.
CONCLUSIONS: Among women undergoing angiography for suspected ischemia, elevated SBP and PP are potent risk factors in premenopausal women. The results suggest that identification of hypertension in premenopausal women dictates additional CAD risk factor assessment and management.
|
Abbreviations and Acronyms
| | CAD = coronary artery disease | | CI = confidence interval | | DBP = diastolic blood pressure | | JNC = Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure | | OR = odds ratio | | PP = pulse pressure | | SBP = systolic blood pressure | | SD = standard deviation | | WISE = Women’s Ischemia Syndrome Evaluation |
|
This article has been cited by other articles:
|
|
|
|
 
J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al.
ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine
J. Am. Coll. Cardiol.,
August 14, 2007;
50(7):
e1 - e157.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Barton, M. R. Meyer, and E. Haas
Hormone Replacement Therapy and Atherosclerosis in Postmenopausal Women: Does Aging Limit Therapeutic Benefits?
Arterioscler Thromb Vasc Biol,
August 1, 2007;
27(8):
1669 - 1672.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Shu, W. Lei, and S. Peng
Recent development of ischaemic heart disease in sex difference
Postgrad. Med. J.,
April 1, 2007;
83(978):
240 - 243.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. M. Kim, J. Park, S. Y. Ryu, and J. Kim
The Effect of Menopause on the Metabolic Syndrome Among Korean Women: The Korean National Health and Nutrition Examination Survey, 2001
Diabetes Care,
March 1, 2007;
30(3):
701 - 706.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J. Pepine
Ischemic Heart Disease in Women
J. Am. Coll. Cardiol.,
February 7, 2006;
47(3_Suppl_S):
S1 - S3.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
