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Risk factors and secondary prevention in women with heart disease: the Heart and Estrogen/progestin Replacement Study

Eric Vittinghoff1, Michael G Shlipak, Paul D Varosy

  • 1University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, 74 New Montgomery, Suite 600, San Francisco, California 94105, USA.

Annals of Internal Medicine
|January 17, 2003
PubMed

Insights

Women with coronary heart disease face high risks, with event rates increasing sixfold when multiple risk factors are present. Secondary prevention medications like aspirin are underused in these high-risk women.

Area of Science:

  • Cardiovascular Medicine
  • Epidemiology
  • Clinical Research

Background:

  • Coronary heart disease (CHD) risk factors are predominantly studied in men.
  • Limited data exists on risk factors and outcomes in women with established CHD.

Purpose of the Study:

  • To evaluate risk factors for coronary events in women with pre-existing coronary disease.
  • To determine event rates and assess the utilization of secondary prevention therapies in this population.

Main Methods:

  • Prospective cohort study within the Heart and Estrogen/progestin Replacement Study (HERS) trial.
  • Involved 2763 postmenopausal women with known coronary disease across 20 U.S. clinical centers.
  • Primary outcome measured was myocardial infarction or death from coronary heart disease.

Main Results:

  • Eleven risk factors were identified, including historical (ethnicity, exercise, diabetes, angina, heart failure, prior myocardial infarction) and measured (blood pressure, cholesterol levels, lipoprotein(a), creatinine clearance).
  • Annual coronary event rates ranged from 1.3% in women with no risk factors to 8.7% in those with five or more, a sixfold increase.
  • Despite high event risk, secondary prevention medication use was suboptimal: aspirin (83%), beta-blockers (33%), ACE inhibitors (18%), and lipid-lowering drugs (53%) at study entry. Women with more risk factors were less likely to receive aspirin and lipid-lowering drugs.

Conclusions:

  • Women with coronary disease are at significant risk of myocardial infarction or death, even without additional risk factors.
  • The presence of multiple risk factors amplifies this risk up to sixfold.
  • Secondary prevention medications, including aspirin, beta-blockers, and lipid-lowering agents, are underutilized in women with coronary disease, particularly those at highest risk.
Abstract

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