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Senior Citizen Health & Medicine
Older Women with even Minor Electrocardiogram
Abnormalities have Increased Death Risk
Should prompt physicians to intensive
therapeutic intervention
 March 7, 2007 - Postmenopausal women without
symptoms of cardiovascular problems who have minor or major
abnormalities on an electrocardiogram are at increased risk for future
cardiovascular events and death, according to a study in the March 7
issue of JAMA.
Resting 12-lead electrocardiogram (ECG)
abnormalities are independently associated with incident coronary heart
disease (CHD) and cardiovascular disease (CVD) events.
Many prior studies included only men or compared
men and women but the women were not selected for age or the presence or
absence of underlying heart disease, according to background information
in the article.
Data are sparse regarding the prevalence,
incidence, and independent prognostic value of minor and/or major
electrocardiographic abnormalities in asymptomatic postmenopausal women.
There is no information on the effect, if any, of hormonal treatment on
the prognostic value of the ECG.
Pablo Denes, M.D., of the Feinberg School of
Medicine, Northwestern University, Chicago, and colleagues conducted a
study to examine the association of baseline and new ECG findings with
CHD and CVD outcomes in the placebo and hormonal treatment groups of the
Womens Health Initiative (WHI) estrogen plus progestin trial.
This portion of the trial, which was stopped in
July 2002, examined whether in healthy postmenopausal women this
combination would reduce CHD and CVD events. The trial found that there
was a significant increase in CHD rates among women taking hormone
therapy compared with the placebo group.
The sample analyzed included 14,749 postmenopausal
asymptomatic women with intact uterus who received 1 daily tablet
containing 0.625 mg of oral conjugated equine estrogen and 2.5 mg of
medroxyprogesterone acetate or a matching placebo. Participants were
enrolled from 1993 to 1998.
The researchers found that among women with absent
(9,744), minor (4,095), and major (910) ECG abnormalities, there were
118, 91, and 37 incident CHD events, respectively.
The incident annual CHD event rates per 10,000
women with absent, minor, or major ECG abnormalities were 21, 40, and
75, respectively.
After 3 years of follow-up, 5 percent of women who
had normal ECG at baseline developed new ECG abnormalities with an
annual CHD event rate of 85 per 10,000 women. There were no significant
interactions between hormone treatment assignment and ECG abnormalities
for risk prediction of cardiovascular end points.
In a large cohort of postmenopausal, asymptomatic
women who were without a history of prior CVD and participating in the
estrogen plus progestin group of the WHI trial, we found that minor and
major baseline ECG abnormalities were associated with significantly
increased risks for CHD and CVD events, independent of established risk
factors and hormone treatment, the authors write.
Given the low cost, wide availability, and ease of
interpretation, the ECG may be a useful tool for assisting in the
prediction of future cardiovascular events in asymptomatic
postmenopausal women. The presence of ECG abnormalities should prompt
physicians to consider further risk stratification, more intensive
therapeutic interventions, or both on modifiable risk factors for
primary prevention of cardiovascular events.
Editor's Note: The Womens Health
Initiative program was funded by the National Heart, Lung, and Blood
Institute of the National Institutes of Health, U.S. Department of
Health and Human Services.
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