Premorbid predictors of death at initial presentation of coronary heart disease in the Women's Health Initiative study
Background: Premorbid health traits that increase the risk of dying at the time of initial presentation of coronary heart disease (CHD) remain poorly characterized. Methods: We followed 148,230 post-menopausal participants in the Women's Health Initiative for a median of 13.3 years. We ascertai...
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Elsevier
2025-03-01
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| Series: | American Journal of Preventive Cardiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666667725000042 |
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| author | Ming-Li Chen Jin Li Kruthika R. Iyer Catherine Tcheandjieu Shirin Jimenez Elias Levy Itshak Salfati Liana C. Del Gobbo Marcia L Stefanick Manisha Desai Xiaonan Xue Themistocles L Assimes |
| author_facet | Ming-Li Chen Jin Li Kruthika R. Iyer Catherine Tcheandjieu Shirin Jimenez Elias Levy Itshak Salfati Liana C. Del Gobbo Marcia L Stefanick Manisha Desai Xiaonan Xue Themistocles L Assimes |
| author_sort | Ming-Li Chen |
| collection | DOAJ |
| description | Background: Premorbid health traits that increase the risk of dying at the time of initial presentation of coronary heart disease (CHD) remain poorly characterized. Methods: We followed 148,230 post-menopausal participants in the Women's Health Initiative for a median of 13.3 years. We ascertained the first occurrence of CHD and performed a joint Cox multivariate regression to identify premorbid predictors for a fatal rather than a non-fatal incident event. Results: A total of 10,714 incident CHD events including 513 fatal events accrued during follow up. A five-year increase in age, smoking 5 to 34 cigarettes per day, and a standard deviation (SD) increase in the Cornel voltage product, an electrocardiographic measure highly correlated with left ventricular mass index on echocardiography, each independently increased the relative risk (RR) of dying from one's initial presentation of CHD by 46 % (95 % confidence interval [CI], 35 to 58 %), 30 % (8 to 51 %,), and 17 % (7 to 28 %), respectively. A high level of recreational physical activity (>1200 metabolic equivalent (MET) minutes per week) reduced one's relative risk by 32 % (12 to 49 %). A significant dose-response effect was observed for both physical activity and smoking and the reduction in absolute risk of presenting with fatal CHD associated with a healthy lifestyle was roughly equivalent to the difference in risk observed among women separated in age by approximately 10 years. Conclusions: Modifiable factors affect a post-menopausal woman's risk of dying from her initial presentation of CHD. Our findings may reduce case-fatality risk of CHD by motivating individuals at risk to adopt and/or adhere to established primary prevention strategies. |
| format | Article |
| id | doaj-art-e63de4721162419c91eabbce55405f63 |
| institution | Kabale University |
| issn | 2666-6677 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Preventive Cardiology |
| spelling | doaj-art-e63de4721162419c91eabbce55405f632025-01-25T04:11:27ZengElsevierAmerican Journal of Preventive Cardiology2666-66772025-03-0121100931Premorbid predictors of death at initial presentation of coronary heart disease in the Women's Health Initiative studyMing-Li Chen0Jin Li1Kruthika R. Iyer2Catherine Tcheandjieu3Shirin Jimenez4Elias Levy Itshak Salfati5Liana C. Del Gobbo6Marcia L Stefanick7Manisha Desai8Xiaonan Xue9Themistocles L Assimes10Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Palo Alto VA Healthcare System, Palo Alto, CA, USADepartment of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Thermo Fisher Scientific, South San Francisco, CA, USADepartment of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Palo Alto VA Healthcare System, Palo Alto, CA, USA; Gladstone Institute of Data Science and Biotechnology, Gladstone Institutes, San Francisco, CA, USADepartment of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Palo Alto VA Healthcare System, Palo Alto, CA, USA; Gladstone Institute of Data Science and Biotechnology, Gladstone Institutes, San Francisco, CA, USADepartment of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Department of Internal Medicine (Division of Cardiovascular Medicine), University of California Davis Health, Davis, CA, USADepartment of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Scripps Research Translational Institute at Scripps Research, La Jolla, CA, USADepartment of Medicine, Stanford University School of Medicine, Stanford, CA, USADepartment of Medicine, Stanford University School of Medicine, Stanford, CA, USADepartment of Medicine, Stanford University School of Medicine, Stanford, CA, USADivision of Biostatistics, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USADepartment of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Palo Alto VA Healthcare System, Palo Alto, CA, USA; Corresponding author at: Palo Alto VA Hospital, 3801 Miranda Ave., Palo Alto, CA 94304, USA.Background: Premorbid health traits that increase the risk of dying at the time of initial presentation of coronary heart disease (CHD) remain poorly characterized. Methods: We followed 148,230 post-menopausal participants in the Women's Health Initiative for a median of 13.3 years. We ascertained the first occurrence of CHD and performed a joint Cox multivariate regression to identify premorbid predictors for a fatal rather than a non-fatal incident event. Results: A total of 10,714 incident CHD events including 513 fatal events accrued during follow up. A five-year increase in age, smoking 5 to 34 cigarettes per day, and a standard deviation (SD) increase in the Cornel voltage product, an electrocardiographic measure highly correlated with left ventricular mass index on echocardiography, each independently increased the relative risk (RR) of dying from one's initial presentation of CHD by 46 % (95 % confidence interval [CI], 35 to 58 %), 30 % (8 to 51 %,), and 17 % (7 to 28 %), respectively. A high level of recreational physical activity (>1200 metabolic equivalent (MET) minutes per week) reduced one's relative risk by 32 % (12 to 49 %). A significant dose-response effect was observed for both physical activity and smoking and the reduction in absolute risk of presenting with fatal CHD associated with a healthy lifestyle was roughly equivalent to the difference in risk observed among women separated in age by approximately 10 years. Conclusions: Modifiable factors affect a post-menopausal woman's risk of dying from her initial presentation of CHD. Our findings may reduce case-fatality risk of CHD by motivating individuals at risk to adopt and/or adhere to established primary prevention strategies.http://www.sciencedirect.com/science/article/pii/S2666667725000042Coronary heart diseaseFatal initial presentationPost-menopausal womenWomen's health initiativeLeft ventricular massElectrocardiography |
| spellingShingle | Ming-Li Chen Jin Li Kruthika R. Iyer Catherine Tcheandjieu Shirin Jimenez Elias Levy Itshak Salfati Liana C. Del Gobbo Marcia L Stefanick Manisha Desai Xiaonan Xue Themistocles L Assimes Premorbid predictors of death at initial presentation of coronary heart disease in the Women's Health Initiative study American Journal of Preventive Cardiology Coronary heart disease Fatal initial presentation Post-menopausal women Women's health initiative Left ventricular mass Electrocardiography |
| title | Premorbid predictors of death at initial presentation of coronary heart disease in the Women's Health Initiative study |
| title_full | Premorbid predictors of death at initial presentation of coronary heart disease in the Women's Health Initiative study |
| title_fullStr | Premorbid predictors of death at initial presentation of coronary heart disease in the Women's Health Initiative study |
| title_full_unstemmed | Premorbid predictors of death at initial presentation of coronary heart disease in the Women's Health Initiative study |
| title_short | Premorbid predictors of death at initial presentation of coronary heart disease in the Women's Health Initiative study |
| title_sort | premorbid predictors of death at initial presentation of coronary heart disease in the women s health initiative study |
| topic | Coronary heart disease Fatal initial presentation Post-menopausal women Women's health initiative Left ventricular mass Electrocardiography |
| url | http://www.sciencedirect.com/science/article/pii/S2666667725000042 |
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