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Risk Factors and Treatment in Women with Coronary Artery Disease FREE

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The summary below is from the full report titled “Risk Factors and Secondary Prevention in Women with Heart Disease: The Heart and Estrogen/progestin Replacement Study.” It is in the 21 January 2003 issue of Annals of Internal Medicine (volume 138, pages 81-89). The authors are E Vittinghoff, MG Shlipak, PD Varosy, CD Furberg, CC Ireland, SS Khan, R Blumenthal, E Barrett-Connor, and S Hulley, for the Heart and Estrogen/progestin Replacement Study Research Group.

Ann Intern Med. 2003;138(2):I-10. doi:10.7326/0003-4819-138-2-200301210-00001
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What is the problem and what is known about it so far?

Coronary heart disease (CHD) is a leading cause of death and disability in middle-aged and older U.S. women. In fact, coronary-related deaths and heart attacks are increasing in U.S. women. Many deaths and heart attacks occur in women with known coronary artery disease. Although we know what risk factors are associated with development of CHD, we don't know specific risk factors for recurrent events in women who already have CHD. Furthermore, we do not know whether women with known CHD receive treatments that are proven beneficial for preventing future CHD events.

Why did the researchers do this particular study?

To see whether women with coronary artery disease were receiving appropriate treatments and to study risk factors for recurrent coronary events in these women.

Who was studied?

2763 postmenopausal women with known CHD. All were younger than 80 years of age.

How was the study done?

Researchers used information from a study that was originally designed to assess benefits of hormone treatment for postmenopausal women. At the start of the study, the researchers asked the women about their lifestyles, medical history, medicines, and symptoms. They measured each woman's blood pressure and weight and performed blood tests for glucose, cholesterol, and creatinine (a measure of kidney function). They followed the women for 4 years to see who had heart attacks or died of coronary artery disease. They then examined the factors that were more common in the women who had heart attacks or died during the follow-up period.

What did the researchers find?

Although all of the women had known coronary artery disease, half or fewer were taking drugs (β-blockers, angiotensin-converting enzyme inhibitors, cholesterol-lowering agents) that help prevent future heart attacks and death. Eleven risk factors were found among the 361 women who had a heart attack or died of coronary disease during follow-up. The risk factors included more than one previous heart attack, kidney dysfunction, diabetes, angina, heart failure, lack of exercise, uncontrolled high blood pressure, abnormal cholesterol levels, and nonwhite ethnicity. Women with five or more risk factors had a rate of coronary events of 8.7% per year, while women with no risk factors had a rate of 1.3% per year.

What were the limitations of the study?

This study was first designed to assess benefits of hormone therapy in postmenopausal women. Participants were volunteers who knew that they had CHD and who were followed closely. They may differ from the general population of middle-aged and older women.

What are the implications of the study?

Doctors should use proven effective medicines more often in women with known coronary artery disease. Also, doctors can identify women with particularly high risks for repeated coronary events.





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