Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among women in the U.S. It accounts for nearly 500,000 deaths annually with coronary artery disease (CAD) accounting for more than half of the deaths. Conventional CAD risk factors are cigarette smoking, dyslipidemias, hypertension, diabetes, and obesity. Oral contraceptive use, menopause, and post-menopausal hormone replacement therapy status have been shown to be unique CAD risk factors for women. CAD primary prevention efforts for both men and women focus on the identification and management of CAD risk factors, yet studies have shown that risk factors predict less than 50 percent of all cardiovascular events and 50 percent of all myocardial infractions occur in individuals with normal plasma lipid levels. In an effort to better identify and stratify risk of atherosclerotic events in healthy populations several new markers of CAD risk have been proposed for use in screening they are: lipoprotein (a) [Lp(a)], homocysteine (tHcy), C-reactive protein (CRP), particle size and various concentrations of low density lipoproteins (LDL) and high density lipoproteins (HDL). This proposal seeks to conduct a pilot study that will explore the prevalence of new markers of CAD risk and clinically measured CAD risk factors among a cohort of self-referred, post-menopausal women who have subclinical CAD as measured by electron beam tomography (EBT) and self-report the absence of conventional CAD risk factors. EBT allows for noninvasive detection and quantification of coronary artery calcium, a subclinical marker for CAD. The results of this pilot study will serve as preliminary data for a future NIH study in post-menopausal women that will investigate the association of new CVD markers and subclinical CAD as measured by EBT. In addition, longitudinal follow-up of a larger cohort will enable the determination of those CAD factors and CVD markers that are most predictive of CAD risk in post-menopausal women. Considering that nearly 50 million American women are now more than 50 years of age, there is not a more important health issue than the primary prevention of CVD.
