Women discharged with diagnoses of nonspecific chest pain (NSCP) may be at increased
risk for subsequent coronary artery disease (CAD) events. The influence of hormone
therapy on NSCP is unknown. The Women's Health Initiative (WHI) enrolled postmenopausal
women aged 50 to 79 years. The duration of follow-up was 7.1 years in the WHI Estrogen-Alone
trial (E-Alone) and 5.6 years in the WHI Estrogen Plus Progestin trial (E+P). After
excluding women with previous cardiovascular disease, 9,427 women in E-Alone and 15,105
women in E+P were included in this analysis. NSCP, defined as having a primary hospital
discharge diagnosis of NSCP by International Classification of Diseases, Ninth Revision,
code, was reported in 322 women in E-Alone and 249 in E+P. Risks for subsequent CAD
events were estimated using intent-to-treat Cox proportional-hazards models stratified
by clinic and adjusted for age and other risk factors. In the fully adjusted models
of the combined trials, women with NSCP had a twofold greater risk for subsequent
nonfatal CAD events, including nonfatal myocardial infarction (2.3% vs 1.7%, hazard
ratio [HR] 2.10, 95% confidence interval [CI] 1.11 to 3.98), revascularization (3.5%
vs 2.6%, HR 1.99, 95% CI 1.20 to 3.30), and hospitalized angina (3.7% vs 2.3%, HR
2.39, 95% CI 1.46 to 3.92). Hormone therapy did not appear to have a significant effect
on either the incidence of NSCP hospitalizations (E-Alone: HR 1.04, 95% CI 0.81 to
1.32; E+P: HR 0.78, 95% CI 0.59 to 1.02) or the risk for a subsequent CAD event. In
conclusion, a hospitalization for NSCP doubles the risk for a subsequent CAD event
in postmenopausal women over the next 5 to 7 years and identifies them as candidates
for aggressive risk factor treatment.
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Article info
Publication history
Published online: July 07, 2008
Accepted:
December 19,
2007
Received in revised form:
December 19,
2007
Received:
October 15,
2007
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
