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    Estrogen therapy and coronary-artery calcification

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    Authors
    Manson, JoAnn E.
    Allison, Matthew A.
    Rossouw, Jacques E.
    Carr, J. Jeffrey
    Langer, Robert D.
    Hsia, Judith
    Kuller, Lewis H.
    Cochrane, Barbara B.
    Hunt, Julie R.
    Ludlam, Shari E.
    Pettinger, Mary B.
    Gass, Margery
    Margolis, Karen L.
    Nathan, Lauren
    Ockene, Judith K.
    Prentice, Ross L.
    Robbins, John
    Stefanick, Marcia L.
    Show allShow less
    UMass Chan Affiliations
    Department of Medicine, Division of Preventive and Behavioral Medicine
    Document Type
    Journal Article
    Publication Date
    2007-06-21
    Keywords
    Calcinosis
    Coronary Angiography
    Coronary Disease
    *Estrogen Replacement Therapy
    Estrogens, Conjugated (USP)
    Female
    Humans
    Hysterectomy
    Logistic Models
    Middle Aged
    Multivariate Analysis
    Odds Ratio
    Postmenopause
    Risk Factors
    Tomography, X-Ray Computed
    Life Sciences
    Medicine and Health Sciences
    Women's Studies
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    Link to Full Text
    http://dx.doi.org/10.1056/NEJMoa071513
    Abstract
    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 (PCONCLUSIONS: 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.)
    Source
    N Engl J Med. 2007 Jun 21;356(25):2591-602. Link to article on publisher's site
    DOI
    10.1056/NEJMoa071513
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/50919
    PubMed ID
    17582069
    Related Resources
    Link to article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1056/NEJMoa071513
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