Research over the years, the Women’s Health Initiative has made lasting contributions to cardiology

BUFFALO, NEW YORK. For nearly 30 years, the Women’s Health Initiative has produced important findings that continue to shed light on the factors that influence disease and risk of death in postmenopausal women. The contribution of the WHI to cardiology is particularly impressive when compared to other well-known studies such as the Framingham and the Atherosclerosis Risk in Communities (ARIC).

The broad scope of the WHI’s impact on cardiovascular health was detailed in a recent article in the Journal of the American College of Cardiology, which invited major cardiovascular disease epidemiologic studies to submit preliminary papers.

“The WHI is the largest study of women’s health, including cardiovascular health, ever conducted in a national cohort of community-recruited older postmenopausal women,” said Michael J. Lamont, Ph.D., professor- researcher in epidemiology and environmental health at the University at Buffalo School of Public Health and Health Professions and lead author of the paper, which included contributions from 20 WHI researchers.

In the 1990s, the Women’s Health Initiative enrolled more than 161,000 women aged 50-79 at study entry. According to Lamont, this provided an unprecedented opportunity to study the development of cardiovascular disease, as well as several other major conditions that contribute to the burden of aging-related diseases among women in later life, such as breast cancer, osteoporosis and cognitive functioning. .

“The WHI is a truly unique population-based study,” Lamont said, adding that it continues to make important contributions through a series of follow-up studies that have allowed researchers to study women over 80 years of age.

“Because women in this age group are the fastest-growing group of adults in terms of an aging population, understanding how to maximize quality of life in this age group is a public health priority in the coming decades that the WHI can uniquely provide.” — Lamont . said

In addition, because of its large size, the WHI was able to publish data on major cardiovascular outcomes, such as first heart attack and stroke, early in the study. It is also one of the largest and most diverse cohorts of American women ever studied.

Thanks to the WHI, researchers learned that cardiovascular disease was the most common cause of death among postmenopausal women in the study, accounting for nearly 31% of deaths reported through March 2021.

Other notable contributions to cardiovascular research include:

  • Reproductive factors such as pregnancy loss, stillbirth, and lack of breastfeeding were evaluated as predictors of coronary heart disease among WHI participants.
  • It found that cardiovascular disease was the leading cause of death within 10 years of diagnosis in women with localized breast cancer diagnosed at age 70 or older.
  • The surprising observation is that lean body mass is more strongly associated with the development of atrial fibrillation than fat mass, and the risk of atrial fibrillation associated with body mass index (BMI) is largely explained by its association with lower lean mass.
  • Using accelerometers worn on the hip for seven consecutive days in 6,489 women aged 63-99, the WHI showed that thresholds for physical activity intensity commonly used for younger people resulted in a significant underestimation of the time spent by older women doing moderate and intense physical activity, and less. intense activities (less than recommended by the guidelines) were associated with lower rates of cardiovascular disease and mortality.
  • It found that only 27% of WHI women reported sleeping 8 hours or more per night. WHI participants with insomnia had a 38% higher risk of coronary heart disease. The WHI Memory Study found that women who slept 6 or less or 8 or more hours a night had a 35% higher risk of cognitive impairment, regardless of cardiovascular status.

And there is much more to come. Lamont and colleagues are currently conducting the WHI Strong and Healthy (WHISH) trial, the first-ever randomized controlled trial of physical activity to prevent primary or first heart attacks and strokes.

“The WHISH study is poised to provide a definitive test of the hypothesis that increased physical activity in later life reduces the risk of heart attack or stroke,” Lamont said, adding that the findings could have a major impact on existing clinical and public health guidelines.

Future additional studies will also focus on cerebrovascular status, blood pressure, and heart failure, as well as the physical and mental impact of the COVID-19 pandemic on aging women.

At the same time, WHI senior scientists continue to train the next generation of researchers, ensuring that there is sufficient intellectual capacity and energy to advance the science of the Women’s Health Initiative into the future, Lamont said.

“I had the opportunity to join WHI at UCLA, and now I’m honored to help grow new researchers in Buffalo and beyond,” he added.

“There are so many opportunities to use the existing WHI data resource to continue to add new information so that we can learn even more about preventing cardiovascular disease and other diseases in older women,” he added.

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