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ARIC, Atherosclerosis Risk in Communities, ASCVD, ASCVD, atherosclerotic cardiovascular disease, CAC, CAC, coronary artery calcium, CHD, coronary heart disease, CVD, cardiovascular disease, EM, early menopause, Early menopause, HT, hormone therapy, MESA, Multi-Ethnic Study of Atherosclerosis, PCE, Pooled Cohort Equations, SWAN, Study of Women's Health Across the Nation, Women, Heart Disease, Heart Disease - Coronary Heart Disease, Aging, Prevention, Cardiovascular, Clinical Research, Atherosclerosis, Detection, screening and diagnosis, 4.2 Evaluation of markers and technologies, and Good Health and Well Being

Background and aimsWe aimed to determine the utility of coronary artery calcium (CAC) for atherosclerotic cardiovascular disease (ASCVD) risk stratification in women with and without early menopause (EM).MethodsTo examine the association between CAC and incident ASCVD, we performed Kaplan-Meier survival analysis and multivariable Cox proportional hazards modeling using data from 2,456 postmenopausal women in the Multi-Ethnic Study of Atherosclerosis (MESA) with or without EM, defined as occurring at 50% of middle-aged postmenopausal women with EM had CAC = 0, similar to those without EM. Among women with CAC = 0, those with EM had a low to borderline 10-year risk of ASCVD, but the 15-year risk was significantly higher for women with EM versus those without EM. When CAC ≥ 1, the incidence of ASCVD was similar for women with and without EM. These findings support the use of CAC to help improve ASCVD risk stratification in women with EM.Condensed abstractThis study investigated the association between coronary artery calcium (CAC) and incident atherosclerotic cardiovascular disease (ASCVD) in postmenopausal women with and without early menopause (EM). We found that >50% of women had CAC = 0 and an associated low-to-borderline 10-year cumulative incidence of ASCVD. However, the risk for ASCVD was significantly higher for women with EM after 15-years follow-up. Additional research is needed to better understand the differences in long-term ASCVD risk between women with and without EM who have CAC = 0.

ACC, American College of Cardiology, AHA, American Heart Association, ASCVD, atherosclerotic cardiovascular disease, ASPC, American Society for Preventive Cardiology, BMI, body mass index, CAC, coronary artery calcium, CCTA, coronary computed tomography angiography, CHD, coronary heart disease, CKD, chronic kidney disease, CRP, C-reactive protein, CVD, cardiovascular disease, Cardiovascular disease, DM, diabetes mellitus, EAS, European Atherosclerosis Society, ESC, European Society of Cardiology, Ethnicity, FH, familial hypercholesterolemia, GDM, gestational diabetes mellitus, IMT, intima media thickness, LDL, low density lipoprotein, MMP, matrix metalloproteinase, NHB, non-Hispanic Black, NHW, non-Hispanic White, PAD, peripheral arterial disease, PCE, pooled cohort equation, PCOS, polycystic ovary syndrome, POI, premature ovarian insufficiency, Primary prevention, Risk assessment, Risk factors inflammation, SDOH, social determinants of health, Secondary prevention, Sex, Subclinical atherosclerosis, VTE, venous thrombotic event, Prevention, Cardiovascular, Heart Disease - Coronary Heart Disease, Patient Safety, Atherosclerosis, Aging, Clinical Research, Heart Disease, and 4.2 Evaluation of markers and technologies

Risk for atherosclerotic cardiovascular disease (ASCVD) shows considerable heterogeneity both in generally healthy persons and in those with known ASCVD. The foundation of preventive cardiology begins with assessing baseline ASCVD risk using global risk scores based on standard office-based measures. Persons at low risk are generally recommended for lifestyle management only and those at highest risk are recommended for both lifestyle and pharmacologic therapy. Additional "risk enhancing" factors, including both traditional risk factors and novel biomarkers and inflammatory factors can be used to further assess ASCVD risk, especially in those at borderline or intermediate risk. There are also female-specific risk enhancers, social determinants of health, and considerations for high-risk ethnic groups. Screening for subclinical atherosclerosis, especially with the use of coronary calcium screening, can further inform the treatment decision if uncertain based on the above strategies. Persons with pre-existing ASCVD also have variable risk, affected by the number of major ASCVD events, whether recurrent events have occurred recently, and the presence of other major risk factors or high-risk conditions. Current guidelines define high to very high risk ASCVD accordingly. Accurate ASCVD risk assessment is crucial for the appropriate targeting of preventive therapies to reduce ASCVD risk. Finally, the clinician-patient risk discussion focusing on lifestyle management and the risks and benefits of evidence-based pharmacologic therapies to best lower ASCVD risk is central to this process. This clinical practice statement provides the preventive cardiology specialist with guidance and tools for assessment of ASCVD risk with the goal of appropriately targeting treatment approaches for prevention of ASCVD events.

Aortic Valve, Mitral Valve, Humans, Calcinosis, Hepatocyte Growth Factor, Aged, Aged, 80 and over, Middle Aged, Female, Male, Atherosclerosis, Biomarkers, Cardiac Imaging Techniques, Epidemiology, Heart Valve Diseases, Heart Disease - Coronary Heart Disease, Aging, Heart Disease, Cardiovascular, and Prevention

BackgroundHepatocyte growth factor (HGF) is a biomarker with potential for use in the diagnosis, treatment and prognostication of cardiovascular disease (CVD). Elevated HGF is associated with calcification in the coronary arteries. However, knowledge is limited on the role HGF may play in extracoronary calcification (ECC). This study examined whether HGF is associated with ECC in the aortic valve (AVC), mitral annulus (MAC), ascending thoracic aorta and descending thoracic aortic (DTAC).MethodsAt baseline, adults aged 45-84 years, free of CVD, in the Multi-Ethnic Study of Atherosclerosis had HGF and ECC measured by ELISA and cardiac CT scan, respectively. ECC measurements were repeated after an average of 2.4 years of follow-up. Prevalent ECC was defined as Agatston score >0 at baseline. Incident ECC was defined as Agatston score >0 at follow-up among participants with Agatston score=0 at baseline. We used Poisson and linear mixed-effects regression models to estimate the association between HGF and ECC, adjusted for sociodemographic and CVD risk factors.ResultsOf 6648 participants, 53% were women. Mean (SD) age was 62 (10) years. Median (IQR) of HGF was 905 (757-1087) pg/mL. After adjustment for CVD risk factors, the highest HGF levels (tertile 3) were associated with greater prevalence and extent of AVC, MAC and DTAC at baseline compared with the lowest tertile (tertile 1). Additionally, the risk of incident AVC and MAC increased by 62% and 45%, respectively, in demographic-adjusted models. However, the associations were not statistically significant in fully adjusted models. The highest HGF levels were also associated with 10% and 13% increase in MAC and DTAC progression, respectively, even after adjustment for CVD risk factors.ConclusionHigher HGF levels were significantly associated with a greater risk of calcification at some extracoronary sites, suggesting an alternate biological pathway that could be targeted to reduce CVD risk.

Humans, Obesity, Body Mass Index, Incidence, Risk Factors, Menopause, Middle Aged, Female, Male, Atherosclerosis, Heart Failure, heart failure, menopause, obesity, Cardiovascular, Aging, Nutrition, Estrogen, Heart Disease, Contraception/Reproduction, 2.1 Biological and endogenous factors, Aetiology, and Cardiorespiratory Medicine and Haematology

Background The mechanisms linking menopausal age and heart failure (HF) incidence are controversial. We investigated for heterogeneity by obesity on the relationship between menopausal age and HF incidence. Methods and Results Using postmenopausal women who attended the Atherosclerosis Risk in Communities Study Visit 4, we estimated hazard ratios of incident HF associated with menopausal age using Cox proportional hazards models, testing for effect modification by obesity and adjusting for HF risk factors. Women were categorized by menopausal age: