The Women's Antioxidant Cardiovascular Study: Design and Baseline Characteristics of Participants

Bassuk, Shari S.; Chen, Albert; Cook, Nancy R.; Zaharris, Elaine; MacFadyen, Jean; Danielson, Eleanor; Denburgh, Martin Van; Buring, Julie E.; Manson, JoAnn E.

doi:10.1089/154099904322836519

Cited by 45 publications

(41 citation statements)

References 50 publications

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“…Previous reports from female health professionals have demonstrated good reliability and validity of self-reported BP. 21,23 However, decreased precision in the reported DBP might explain, in part, the weak and primarily positive relation observed between DBP and CVD risk and the weaker risk prediction from PP. Although the same limitation applies to SBP, it had a powerful and compelling relation with CVD risk.…”

Section: Discussionmentioning

confidence: 99%

“…21 CVD was defined as a self-reported history of myocardial infarction (MI), angina pectoris, coronary revascularization, stroke, transient cerebral ischemia, carotid endarterectomy, or peripheral artery surgery on the baseline questionnaire. Primary exclusion criteria for enrollment were history of cancer (except for nonmelanoma skin cancer), active liver disease or cirrhosis, chronic kidney failure, current use of warfarin or other anticoagulant, or unwillingness to comply with study medications or to withhold use of out-of-study vitamin supplements.…”

Section: Study Populationmentioning

confidence: 99%

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Blood Pressure and Risk of Secondary Cardiovascular Events in Women

et al. 2004

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Background-In apparently healthy people, the relation between blood pressure and risk of subsequent cardiovascular disease (CVD) is linear. In persons with CVD, the relation is uncertain. Methods and Results-We conducted a prospective study of 5218 older women with CVD who reported their blood pressure at baseline in the Women's Antioxidant Cardiovascular Study (WACS), an ongoing double-blind, placebocontrolled secondary prevention trial of the benefits and risks of antioxidant vitamins, folic acid, vitamin B 6 , and vitamin B 12 among women with CVD or Ն3 coronary risk factors. A total of 661 confirmed CVD events (nonfatal myocardial infarction, nonfatal stroke, coronary artery bypass graft procedure, percutaneous coronary angioplasty, or CVD death) occurred during a median follow-up of 6.5 years. After controlling for age, randomized treatment assignment, antihypertensive medication use, and coronary risk factors, we found that systolic blood pressure (SBP) was a strong predictor of CVD events and that the relation between SBP and CVD risk was positive, continuous, and linear (P for linear trendϭ0.001). For each 10-mm Hg increment in SBP, there was a 9% (95% CI 4% to 15%) increase in risk of secondary CVD events. Diastolic blood pressure, mean arterial pressure, and pulse pressure were weaker predictors of CVD risk in this cohort, and joint consideration of SBP and diastolic blood pressure found that only SBP significantly predicted risk. Use of antihypertensive medication did not modify the relationship of SBP with CVD events. Conclusions-In this population of women with CVD, we observed a strong, continuous, and linear association between SBP and risk of secondary CVD events. SBP was the blood pressure measure most strongly related to CVD risk.

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Section: Discussionmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Blood Pressure and Risk of Secondary Cardiovascular Events in Women

et al. 2004

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“…Interactions between antioxidant vitamins and folic acid were plausible because homocysteine lowering might have antioxidant effects. 10 Details of the overall trial design 11 and the results for the antioxidant group have been reported previously. 12 This report describes the CVD results of the folic acid, vitamin B 6 , and vitamin B 12 combination pill treatment group (FIGURE 1).…”

Section: Methodsmentioning

confidence: 99%

Effect of Folic Acid and B Vitamins on Risk of Cardiovascular Events and Total Mortality Among Women at High Risk for Cardiovascular Disease

Chen¹,

Cook²,

Gaziano³

et al. 2008

JAMA

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452

342

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OMOCYSTEINE LEVELS HAVEbeen directly associated with cardiovascular risk in observational studies 1 ; and daily supplementation with folic acid, vitamin B 6 , vitamin B 12 , or a combination have been shown to reduce homocysteine levels to varying degrees in intervention studies. 2 Based on these data, several randomized trials were designed to test the hypothesis that supplementation with folic acid or B vitamins or both would prevent cardiovascular disease (CVD). However, published trials on patients with preexisting vascular disease have not demonstrated a benefit of folic acid or B vitamins on CVD risk. 3 Participants in observational studies were followed up for longer durations then participants in randomized trials 1 ; therefore, it is plausible that homocysteine lowering may have had a greater effect if participants were treated and observed for longer periods of time. Metaanalyses of randomized trials sug-For editorial comment see p 2086.

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“…A recent secondary prevention trial in patients with stroke failed to demonstrate a benefit from vitamin therapy in reducing atherothrombotic outcomes, 14 but there are several other studies underway aimed at answering this question. 15,16 However, because of the recent adoption of mandatory folate supplementation in all grain-based products in the United States, there will be even less baseline variation among study participants and controls, which will make demonstrating statistically significant differences even more challenging.…”

Section: Homocysteinementioning

confidence: 99%

Assessment of Hemostatic Risk Factors in Predicting Arterial Thrombotic Events

Feinbloom

Bauer

2005

ATVB

108

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Abstract-Arterial thrombosis results from endovascular injury and, to a lesser extent, alterations in hemostatic equilibrium. Although multiple hereditary and acquired hemostatic risk factors have been described in the pathophysiology of venous thrombosis, the degree and type of abnormalities that contribute to arterial thrombosis are less well understood. Endothelial cell injury with the elaboration of proinflammatory mediators stimulates the process of arterial thrombosis. Although this is most often the result of endovascular injury attributable to atherosclerotic disease, other disease states can elicit a similar response as well. Similarly, once thrombosis has been initiated, variations in the activity of coagulation proteins and endogenous anticoagulants, as well as the kinetics of platelet aggregation, may alter the effectiveness of thrombus formation. Epidemiological studies have identified several acquired or inherited states that may result in endothelial damage or altered hemostatic equilibrium, thereby predisposing patients to arterial thrombosis. These include hyperhomocysteinemia, elevated C-reactive protein, antiphospholipid antibodies, elevated fibrinogen, Factor VII, plasminogen activator inhibitor-1 (PAI-1), hereditary thrombophilias, and platelet hyper-reactivity. This review explores our present understanding of these risk factors in the development of arterial thrombotic events. At present, the literature supports a role for hyperhomocysteinemia, elevated C-reactive protein, and elevated fibrinogen as risk factors for arterial thrombosis. Similarly, the literature suggests that lupus anticoagulants and, to a lesser extent, elevated titers of cardiolipin IgG antibodies predispose to arterial vascular events. In certain subsets of patients, including those with concomitant cardiac risk factors, Ͻ55 years of age, and women, hereditary thrombophilias such as carriership of the factor V Leiden and the prothrombin G20210A mutations may confer a higher risk of arterial thrombosis. However, the data on Factor VII, PAI-1, and platelet receptor polymorphisms are contradictory or lacking.

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The Women's Antioxidant Cardiovascular Study: Design and Baseline Characteristics of Participants

Cited by 45 publications

References 50 publications

Blood Pressure and Risk of Secondary Cardiovascular Events in Women

Blood Pressure and Risk of Secondary Cardiovascular Events in Women

Effect of Folic Acid and B Vitamins on Risk of Cardiovascular Events and Total Mortality Among Women at High Risk for Cardiovascular Disease

Assessment of Hemostatic Risk Factors in Predicting Arterial Thrombotic Events

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