Abstract 17338: Predictors of Fatal Incident Coronary Heart Disease in the Women’s Health Initiative
Introduction: Identifying predictors of a fatal incident CHD may allow us to better understand the pathophysiology of fatal events and to reduce case-fatality rates through more efficient implementation of primary prevention strategies. Studies to date in this regard have been limited in number and power.
Hypothesis: We tested the hypothesis that several established risk factors for CHD including smoking and exercise as well as the use of aspirin, statins, and beta-blockers are associated with fatal incident CHD in the Women’s Health Initiative.
Methods: We identified post-menopausal women 50-79 years of age at baseline with no prior history of CVD who developed at least one adjudicated event of coronary revascularization, myocardial infarction, or definitive fatal CHD during follow up. We defined fatal cases as cases with definitive fatal CHD within 28 days of an incident CHD event. The remaining non-fatal incident cases served as the comparison group. We then performed a Cox regression to identify independent predictors of a fatal mode of presentation of incident CHD. Risk factors and drug use measured at multiple time points were modeled as time-dependent covariates.
Results: A total of 8,744 incident including 521 fatal CHD cases accrued among 148,843 participants over 19.4 years. Aspirin, statins, beta-blockers, and recreational physical activity independently reduced the risk of a fatal CHD while older age, current smoking, hypertension, diabetes, BMI, LVH on EKG, and African American ancestry all increased risk. Other major classes of antihypertensive drugs, education, income, diet quality, lipids, and a genetic risk score of CHD had no significant effect. The table summarizes the magnitude of effects.
Conclusions: Multiple modifiable risk factors and classes of CVD drugs substantially affect a woman’s risk of dying from her initial presentation of CHD. Our findings may help motivate subjects at risk to adhere to established primary prevention strategies.
Author Disclosures: S. Zarafshar: None. J. Li: None. E. Salfati: None. L. Del Gobbo: None. T.L. Assimes: Research Grant; Significant; Telomere Diagnostics, Regeneron Genetics Center.
- © 2016 by American Heart Association, Inc.