The Role of Sex-Specific Risk Factors in the Risk Assessment of Atherosclerotic Cardiovascular Disease for Primary Prevention in Women | springermedizin.de

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Current Atherosclerosis Reports

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01.09.2020 | Women and Ischemic Heart Disease (P. Kohli, Section Editor)

The Role of Sex-Specific Risk Factors in the Risk Assessment of Atherosclerotic Cardiovascular Disease for Primary Prevention in Women

verfasst von: Priya M. Freaney, Sadiya S. Khan, Donald M. Lloyd-Jones, Neil J. Stone

Erschienen in: Current Atherosclerosis Reports | Ausgabe 9/2020

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Abstract

Purpose of Review

Robust evidence is emerging regarding the contribution of sex-specific risk factors to a woman’s unique risk of atherosclerotic cardiovascular disease (ASCVD). This review summarizes the available literature regarding the association of sex-specific risk factors and ASCVD in women.

Recent Findings

The American College of Cardiology and American Heart Association Guidelines recommend estimation of 10-year risk of a first ASCVD event using the 2013 Pooled Cohort Equations. This can be further personalized by identifying sex-specific risk factors present in a woman’s history. There are multiple vulnerable periods across a woman’s life course that are associated with increased risk of ASCVD. Risk factors across the reproductive life course that have been shown to correlate with higher risk for future ASCVD include early menarche, adverse pregnancy outcomes (such as pre-eclampsia or preterm birth), and early natural or surgical menopause. In addition, certain conditions that are more common among women, including autoimmune diseases, history of chest irradiation, and certain chemotherapies, also need to be considered. Finally, risk assessment can be refined with subclinical disease imaging (coronary calcium score) if there remains uncertainty about clinical management with lipid-lowering therapies for primary prevention after inclusion of these risk enhancers.

Summary

Risk assessment for ASCVD in women requires a personalized approach that incorporates sex-specific risk factors to guide primary prevention measures, such as lipid-lowering therapies. Coronary calcium score imaging may also help further refine risk assessment, but no clinical trials conducted to date have addressed this question.

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1.

Heron M. Deaths: leading causes for 2017. National Vital Stat Rep. 2019, 68(6). Hyattsville, MD: National Center for Health Statistics. 2019. Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_06-508.pdf.

2.

World health statistics 2019: monitoring health for the SDGs, sustainable development goals. World Health Organization. 2019.

3.

Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S1–45.PubMed

4.

•• Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. J Am Coll Cardiol. 2019;73(24):e285–350 Guideline document that highlights importance of incorporating risk enhancing factors and sex-specific risk factors into primary prevention risk assessment.PubMed

5.

Lloyd-Jones DM, Braun LT, Ndumele CE, Smith SC Jr, Sperling LS, Virani SS, et al. Use of risk assessment tools to guide decision-making in the primary prevention of atherosclerotic cardiovascular disease: a special report from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2019;73(24):3153–67.PubMed

6.

Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596–646.PubMed

7.

Stuart JJ, Tanz LJ, Cook NR, Spiegelman D, Missmer SA, Rimm EB, et al. Hypertensive disorders of pregnancy and 10-year cardiovascular risk prediction. J Am Coll Cardiol. 2018;72(11):1252–63.PubMedPubMedCentral

8.

Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB Sr, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2935–59.PubMed

9.

Ley SH, Li Y, Tobias DK, Manson JE, Rosner B, Hu FB, et al. Duration of reproductive life span, age at menarche, and age at menopause are associated with risk of cardiovascular disease in women. J Am Heart Assoc. 2017;6(11): e006713.

10.

Peters SAE, Woodward M. Women’s reproductive factors and incident cardiovascular disease in the UK Biobank. Heart. 2018;104(13):1069–75.PubMed

11.

Canoy D, Beral V, Balkwill A, Wright FL, Kroll ME, Reeves GK, et al. Age at menarche and risks of coronary heart and other vascular diseases in a large UK cohort. Circulation. 2015;131(3):237–44.PubMed

12.

Lee JJ, Cook-Wiens G, Johnson BD, Braunstein GD, Berga SL, Stanczyk FZ, et al. Age at menarche and risk of cardiovascular disease outcomes: findings from the National Heart Lung and Blood Institute-sponsored women’s ischemia syndrome evaluation. J Am Heart Assoc. 2019;8(12):e012406.PubMedPubMedCentral

13.

Bertone-Johnson ER, Whitcomb BW, Rich-Edwards JW, Hankinson SE, Manson JE. Premenstrual syndrome and subsequent risk of hypertension in a prospective study. Am J Epidemiol. 2015;182(12):1000–9.PubMedPubMedCentral

14.

Li W, Ruan W, Lu Z, Wang D. Parity and risk of maternal cardiovascular disease: a dose–response meta-analysis of cohort studies. Eur J Prev Cardiol. 2019;26(6):592–602.PubMed

15.

Oliver-Williams C, Vladutiu CJ, Loehr LR, Rosamond WD, Stuebe AM. The association between parity and subsequent cardiovascular disease in women: the atherosclerosis risk in communities study. J Women's Health. 2019;28(5):721–7.

16.

Okby R, Shoham-Vardi I, Sergienko R, Sheiner E. Twin pregnancy: is it a risk factor for long-term cardiovascular disease? J Matern Fetal Neonatal Med. 2016;29(10):1626–30.PubMed

17.

Kirkegaard H, Bliddal M, Stovring H, Rasmussen KM, Gunderson EP, Kober L, et al. Breastfeeding and later maternal risk of hypertension and cardiovascular disease-the role of overall and abdominal obesity. Prev Med. 2018;114:140–8.PubMed

18.

Brown MC, Best KE, Pearce MS, Waugh J, Robson SC, Bell R. Cardiovascular disease risk in women with pre-eclampsia: systematic review and meta-analysis. Eur J Epidemiol. 2013;28(1):1–19.PubMed

19.

Ahmed R, Dunford J, Mehran R, Robson S, Kunadian V. Pre-eclampsia and future cardiovascular risk among women: a review. J Am Coll Cardiol. 2014;63(18):1815–22.PubMed

20.

Leon LJ, McCarthy FP, Direk K, Gonzalez-Izquierdo A, Prieto-Merino D, Casas JP, et al. Preeclampsia and cardiovascular disease in a large UK pregnancy cohort of linked electronic health records: a CALIBER study. Circulation. 2019;140(13):1050–60.PubMed

21.

•• Honigberg MC, Zekavat SM, Aragam K, Klarin D, Bhatt DL, Scott N, et al. Hypertensive disorders of pregnancy are associated with long-term risk of diverse cardiovascular disease. Circulation. 2019;74(22):2743–2754. Women who have a hypertensive disorder of pregnancy are at higher long-term risk for a diverse group of cardiovascular disease.

22.

Veerbeek JHW, Hermes W, Breimer AY, Van Rijn BB, Koenen SV, Mol BW, et al. Cardiovascular disease risk factors after early-onset preeclampsia, late-onset preeclampsia, and pregnancy-induced hypertension. Hypertension. 2015;65(3):600–6.PubMed

23.

Brouwers L, van der Meiden-van Roest AJ, Savelkoul C, Vogelvang TE, Lely AT, Franx A, et al. Recurrence of pre-eclampsia and the risk of future hypertension and cardiovascular disease: a systematic review and meta-analysis. BJOG. 2018;125(13):1642–54.PubMedPubMedCentral

24.

Kessous R, Shoham-Vardi I, Pariente G, Sergienko R, Sheiner E. Long-term maternal atherosclerotic morbidity in women with pre-eclampsia. Heart. 2015;101(6):442–6.PubMed

25.

Bergman L, Callbo PN, Hesselman S, Wikström AK, Edstedt Bonamy AK, Sandström A. Women with preeclampsia in a multiple pregnancy have no association with increased risk of future cardiovascular disease; a national register-based cohort study. Pregnancy Hypertens. 2019;17:S7.

26.

• Haug EB, Horn J, Markovitz AR, Fraser A, Klykken B, Dalen H, et al. Association of conventional cardiovascular risk factors with cardiovascular disease after hypertensive disorders of pregnancy: analysis of the Nord-Trøndelag Health Study. JAMA Cardiol. 2019;4(7):628–35 The elevated risk of cardiovascular disease risk in women with hypertensive disorders of pregnancy can be in part attributed to traditional ASCVD risk factors, which should be targeted for prevention.PubMedPubMedCentral

27.

Stuart JJ, Tanz LJ, Missmer SA, Rimm EB, Spiegelman D, James-Todd TM, et al. Hypertensive disorders of pregnancy and maternal cardiovascular disease risk factor development: an observational cohort study. Ann Intern Med. 2018;169(4):224–32.PubMedPubMedCentral

28.

Riise HKR, Sulo G, Tell GS, Igland J, Egeland G, Nygard O, et al. Hypertensive pregnancy disorders increase the risk of maternal cardiovascular disease after adjustment for cardiovascular risk factors. Int J Cardiol. 2019;282:81–7.PubMed

29.

Huang J, Eisaman D, Berlacher K, Suyama J. Follow-up for cardiovascular disease risk in women with preeclampsia one year after delivery. Circulation. 2018;138:A15129.

30.

• Timpka S, Fraser A, Schyman T, Stuart JJ, Åsvold BO, Mogren I, et al. The value of pregnancy complication history for 10-year cardiovascular disease risk prediction in middle-aged women. Eur J Epidemiol. 2018;33(10):1003–10 The addition of adverse pregnancy outcomes to already existing ASCVD risk prediction models has not been shown to improve discrimination or reclassification.PubMedPubMedCentral

31.

Markovitz AR, Stuart JJ, Horn J, Williams PL, Rimm EB, Missmer SA, et al. Does pregnancy complication history improve cardiovascular disease risk prediction? Findings from the HUNT study in Norway. Eur Heart J. 2019;40(14):1113–20.PubMed

32.

Catov JM, Countouris M, Hauspurg A. Hypertensive disorders of pregnancy and CVD prediction: accounting for risk accrual during the reproductive years. J Am Coll Cardiol. 2018;72(11):1264–6.PubMed

33.

Lavery JA, Friedman AM, Keyes KM, Wright JD, Ananth CV. Gestational diabetes in the United States: temporal changes in prevalence rates between 1979 and 2010. BJOG. 2017;124(5):804–13.PubMed

34.

• Hopmans TEJP, van Houten C, Kasius A, Kouznetsova OI, Nguyen LA, Rooijmans SV, et al. Increased risk of type II diabetes mellitus and cardiovascular disease after gestational diabetes mellitus: a systematic review. Ned Tijdschr Geneeskd. 2015;159:A8043 Women with gestational diabetes have a 7- to 13-fold higher risk of developing type 2 diabetes mellitus than women without gestational diabetes.PubMed

35.

Tobias DK, Stuart JJ, Li S, Chavarro J, Rimm EB, Rich-Edwards J, et al. Association of history of gestational diabetes with long-term cardiovascular disease risk in a large prospective cohort of US women. JAMA Intern Med. 2017;177(12):1735–42.PubMedPubMedCentral

36.

Kramer CK, Campbell S, Retnakaran R. Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis. Diabetologia. 2019;62(6):905–14.PubMed

37.

Gunderson EP, Chiang V, Pletcher MJ, Jacobs DR, Quesenberry CP, Sidney S, et al. History of gestational diabetes mellitus and future risk of atherosclerosis in mid-life: the Coronary Artery Risk Development in Young Adults study. J Am Heart Assoc. 2014;3(2):e000490.PubMedPubMedCentral

38.

Kaul P, Savu A, Nerenberg KA, Donovan LE, Chik CL, Ryan EA, et al. Impact of gestational diabetes mellitus and high maternal weight on the development of diabetes, hypertension and cardiovascular disease: a population-level analysis. Diabet Med. 2015;32(2):164–73.PubMed

39.

Retnakaran R, Shah BR. Glucose screening in pregnancy and future risk of cardiovascular disease in women: a retrospective, population-based cohort study. Lancet Diabetes Endocrinol. 2019;7(5):378–84.PubMed

40.

Catov JM, Newman AB, Roberts JM, Sutton-Tyrrell KC, Kelsey SF, Harris T, et al. Association between infant birth weight and maternal cardiovascular risk factors in the health, aging, and body composition study. Ann Epidemiol. 2007;17(1):36–43.PubMed

41.

Grandi SM, Filion KB, Yoon S, Ayele HT, Doyle CM, Hutcheon JA, et al. Cardiovascular disease-related morbidity and mortality in women with a history of pregnancy complications: systematic review and meta-analysis. Circulation. 2019;139(8):1069–79.PubMed

42.

Kessous R, Shoham-Vardi I, Pariente G, Holcberg G, Sheiner E. An association between preterm delivery and long-term maternal cardiovascular morbidity. Am J Obstet Gynecol. 2013;209(4):368 e1–8.

43.

Robbins CL, Hutchings Y, Dietz PM, Kuklina EV, Callaghan WM. History of preterm birth and subsequent cardiovascular disease: a systematic review. Am J Obstet Gynecol. 2014;210(4):285–97.PubMed

44.

Ngo AD, Roberts CL, Chen JS, Figtree G. Interaction of maternal smoking and preterm birth on future risk of maternal cardiovascular disease: a population-based record linkage study. Eur J Prev Cardiol. 2016;23(6):613–20.PubMed

45.

Auger N, Potter BJ, He S, Healy-Profitos J, Schnitzer ME, Paradis G. Maternal cardiovascular disease 3 decades after preterm birth: longitudinal cohort study of pregnancy vascular disorders. Hypertension. 2020;75(3):788–795.

46.

Ngo AD, Chen JS, Figtree G, Morris JM, Roberts CL. Preterm birth and future risk of maternal cardiovascular disease-is the association independent of smoking during pregnancy? BMC Pregnancy Childbirth. 2015;15(144).

47.

• Horn J, Tanz LJ, Stuart JJ, Markovitz AR, Skurnik G, Rimm EB, et al. Early or late pregnancy loss and development of clinical cardiovascular disease risk factors: a prospective cohort study. BJOG. 2019;126(1):33–42 Spontaneous pregnancy loss is associated with increased risk of hypertension, type 2 diabetes mellitus, and hyperlipidemia.PubMed

48.

Ranthe MF, Andersen EAW, Wohlfahrt J, Bundgaard H, Melbye M, Boyd HA. Pregnancy loss and later risk of atherosclerotic disease. Circulation. 2013;127(17):1775–82.PubMed

49.

Kharazmi E, Dossus L, Rohrmann S, Kaaks R. Pregnancy loss and risk of cardiovascular disease: a prospective population-based cohort study (EPIC-Heidelberg). Heart. 2011;97(1):49–54.PubMed

50.

Hall PS, Nah G, Vittinghoff E, Parker DR, Manson JE, Howard BV, et al. Relation of pregnancy loss to risk of cardiovascular disease in parous postmenopausal women (from the Women’s Health Initiative). Am J Cardiol. 2019;123(10):1620–5.PubMedPubMedCentral

51.

Lidegaard O, Lokkegaard E, Jensen A, Skovlund CW, Keiding N. Thrombotic stroke and myocardial infarction with hormonal contraception. N Engl J Med. 2012;366:2257–66.PubMed

52.

Anderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA. 2004;291(14):1701–12.PubMed

53.

Main C, Knight B, Moxham T, Gabriel Sanchez R, Sanchez Gomez LM, Roquéi Figuls M, et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev. 2015;3:CD002229.

54.

Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2010;16(4):347–63.PubMed

55.

Kazemi M, Pierson RA, Lujan ME, Chilibeck PD, McBreairty LE, Gordon JJ, et al. Comprehensive evaluation of type 2 diabetes and cardiovascular disease risk profiles in reproductive-age women with polycystic ovary syndrome: a large Canadian cohort. J Obstet Gynaecol Can. 2019;41(10):1453–60.PubMed

56.

Wild S, Pierpoint T, McKeigue P, Jacobs H. Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up: a retrospective cohort study. Clin Endocrinol. 2000;52:595–600.

57.

•• Honigberg MC, Zekavat SM, Aragam K, Finneran P, Klarin D, Bhatt DL, et al. Association of premature natural and surgical menopause with incident cardiovascular disease. JAMA. 2019;322(24):2411–21 Natural or surgical menopause before the age of 40 is associated with increased risk of cardiovascular disease.

58.

Atsma F, Bartelink MLEL, Grobbee DE, Van Der Schouw YT. Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis. Menopause. 2006;13(2):265–79.PubMed

59.

De Kat AC, Verschuren WM, Eijkemans MJ, Van Der Schouw YT, Broekmans FJ. The association of low ovarian reserve with cardiovascular disease risk: a cross-sectional population-based study. Hum Reprod. 2016;31(8):1866–74.

60.

Zhu D, Chung HF, Pandeya N, Dobson AJ, Hardy R, Kuh D, et al. Premenopausal cardiovascular disease and age at natural menopause: a pooled analysis of over 170,000 women. Eur J Epidemiol. 2019;34(3):235–46.PubMed

61.

Matthews KA, Crawford SL, Chae CU, Everson-Rose SA, Sowers MF, Sternfeld B, et al. Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition? J Am Coll Cardiol. 2009;54(25):2366–73.PubMedPubMedCentral

62.

Asanuma Y, Oeser A, Shintani A, Turner E, Olsen N, Fazio S, et al. Premature coronary-artery atherosclerosis in systemic lupus erythematosus. N Engl J Med. 2003;349:2407–15.PubMed

63.

Roman MJ, Shanker B, Davis A, Lockshin MD, Sammaritano L, Simantov R, et al. Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Engl J Med. 2003;349:2399–406.PubMed

64.

Simard JF, Rossides M, Arkema EV, Svenungsson E, Wikstrom AK, Mittleman MA, et al. Maternal hypertensive disorders in SLE pregnancy and future cardiovascular outcomes. Arthritis Care Res. 2020. https://doi.org/10.1002/acr.24160.

65.

Myasoedova E, Chandran A, Ilhan B, Major BT, Michet CJ, Matteson EL, et al. The role of rheumatoid arthritis (RA) flare and cumulative burden of RA severity in the risk of cardiovascular disease. Ann Rheum Dis. 2016;75(3):560–5.PubMed

66.

Kurmann RD, Mankad R. Atherosclerotic vascular disease in the autoimmune rheumatologic woman. Clin Cardiol. 2018;41(2):258–63.PubMedPubMedCentral

67.

Giordano SH, Longo DL. Breast cancer in men. N Engl J Med. 2018;378(24):2311–20.PubMed

68.

•• Mehta LS, Watson KE, Barac A, Beckie TM, Bittner V, Cruz-Flores S, et al. Cardiovascular disease and breast cancer: where these entities intersect: a scientific statement from the American Heart Association. Circulation. 2018;137(8):e30–66 Scientific statement highlighting the need to focus on cardiovascular disease prevention in all breast cancer survivors.PubMedPubMedCentral

69.

Xie Y, Collins WJ, Audeh MW, Shiao SL, Gottlieb RA, Goodman MT, et al. Breast cancer survivorship and cardiovascular disease: emerging approaches in cardio-oncology. Curr Treat Options Cardiovasc Med. 2015;17(12):60.

70.

Hamood R, Hamood H, Merhasin I, Keinan-Boker L. Risk of cardiovascular disease after radiotherapy in survivors of breast cancer: a case-cohort study. J Cardiol. 2019;73(4):280–91.PubMed

71.

Gidding SS, Champagne MA, de Ferranti SD, Defesche J, Ito MK, Knowles JW, et al. The agenda for familial hypercholesterolemia: a scientific statement from the American Heart Association. Circulation. 2015;132(22):2167–92.PubMed

72.

Perak AM, Ning H, de Ferranti SD, Gooding HC, Wilkins JT, Lloyd-Jones DM. Long-term risk of atherosclerotic cardiovascular disease in US adults with the familial hypercholesterolemia phenotype. Circulation. 2016;134(1):9–19.PubMedPubMedCentral

73.

Do R, Stitziel NO, Won HH, Jorgensen AB, Duga S, Angelica Merlini P, et al. Exome sequencing identifies rare LDLR and APOA5 alleles conferring risk for myocardial infarction. Nature. 2015;518(7537):102–6.PubMed

74.

Trinder M, Li X, DeCastro ML, Cermakova L, Sadananda S, Jackson LM, et al. Risk of premature atherosclerotic disease in patients with monogenic versus polygenic familial hypercholesterolemia. J Am Coll Cardiol. 2019;74(4):512–22.PubMed

75.

Sniderman AD, Tsimikas S, Fazio S. The severe hypercholesterolemia phenotype: clinical diagnosis, management, and emerging therapies. J Am Coll Cardiol. 2014;63(19):1935–47.PubMed

76.

Knowles JW, Stone NJ, Ballantyne CM. Familial hypercholesterolemia and the 2013 American College of Cardiology/American Heart Association Guidelines: myths, oversimplification, and misinterpretation versus facts. Am J Cardiol. 2015;116(3):481–4.PubMed

77.

Shatzel JJ, Connelly KJ, DeLoughery TG. Thrombotic issues in transgender medicine: a review. Am J Hematol. 2017;92(2):204–8.PubMed

78.

den Heijer M, Bakker A, Gooren L. Long term hormonal treatment for transgender people. BMJ. 2017;359:j5027.

79.

• Budoff MJ, Young R, Burke G, Jeffrey Carr J, Detrano RC, Folsom AR, et al. Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J. 2018;39(25):2401–8 Coronary artery calcium is robustly associated with fatal and non-fatal myocardial infarction and stroke over a 10-year period.PubMedPubMedCentral

80.

Plank F, Beyer C, Friedrich G, Wildauer M, Feuchtner G. Sex differences in coronary artery plaque composition detected by coronary computed tomography: quantitative and qualitative analysis. Neth Hear J. 2019;27(5):272–80.

81.

Bigeh A, Shekar C, Gulati M. Sex differences in coronary artery calcium and long-term CV mortality. Curr Cardiol Rep. 2020;22(4):21.PubMed

82.

McClelland RL, Jorgensen NW, Budoff M, Blaha MJ, Post WS, Kronmal RA, et al. 10-year coronary heart disease risk prediction using coronary artery calcium and traditional risk factors: derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) with validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study). J Am Coll Cardiol. 2015;66(15):1643–53.PubMedPubMedCentral

83.

Nasir K, Bittencourt MS, Blaha MJ, Blankstein R, Agatson AS, Rivera JJ, et al. Implications of coronary artery calcium testing among statin candidates according to American College of Cardiology/American Heart Association Cholesterol Management Guidelines: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2015;66(15):1657–68.PubMed

84.

Yoon YE, Kim KM, Han JS, Kang SH, Chun EJ, Ahn S, et al. Prediction of subclinical coronary artery disease with breast arterial calcification and low bone mass in asymptomatic women: registry for the women health cohort for the BBC study. JACC Cardiovasc Imaging. 2019;12(7 Pt 1):1202–11.PubMed

85.

Bui QM, Daniels LB. A review of the role of breast arterial calcification for cardiovascular risk stratification in women. Circulation. 2019;139(8):1094–101.PubMed

86.

Newallo D, Meinel FG, Schoepf UJ, Baumann S, De Cecco CN, Leddy RJ, et al. Mammographic detection of breast arterial calcification as an independent predictor of coronary atherosclerotic disease in a single ethnic cohort of African American women. Atherosclerosis. 2015;242(1):218–21.PubMed

Titel: The Role of Sex-Specific Risk Factors in the Risk Assessment of Atherosclerotic Cardiovascular Disease for Primary Prevention in Women
verfasst von: Priya M. Freaney
Sadiya S. Khan
Donald M. Lloyd-Jones
Neil J. Stone
Publikationsdatum: 01.09.2020
Verlag: Springer US
Erschienen in: Current Atherosclerosis Reports / Ausgabe 9/2020
Print ISSN: 1523-3804
Elektronische ISSN: 1534-6242
DOI: https://doi.org/10.1007/s11883-020-00864-6

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