Coronary artery calcification in middle-aged women with premature ovarian insufficiency

Marlise N. Gunning; Cindy Meun; Bas B. van Rijn; Angela H.E.M. Maas; Laura Benschop; Arie Franx; Eric Boersma; Ricardo P.J. Budde; Yolande Appelman; Cornelis B. Lambalk; Rene Eijkemans; Birgitta K. Velthuis; Joop S.E. Laven; Bart C.J.M. Fauser; Sara Baart; Laura Brouwers; Suzanne Cannegieter; Veerle Dam; Nadine Daan; Rene Eijkemans; Michel Ferrari; Christianne de Groot; Annemieke Hoek; Erik Koffijberg; Wendy Koster; Mark Kruit; Giske Lagerweij; Nils Lambalk; Katie Linstra; Aad van der Lugt; Antoinette Maassen van den Brink; Saskia Middeldorp; Karel Moons; Jeanine Roeters van Lennep; Jolien Roos-Hesselink; Luuk Scheres; Yvonne van der Schouw; Eric Steegers; Regine Steegers; Gisela Terwindt; Marieke Wermer; Bart Zick; Gerbrand Zoet

doi:10.1111/cen.14003

Coronary artery calcification in middle-aged women with premature ovarian insufficiency

Marlise N. Gunning^*, Cindy Meun, Bas B. van Rijn, Angela H.E.M. Maas, Laura Benschop, Arie Franx, Eric Boersma, Ricardo P.J. Budde, Yolande Appelman, Cornelis B. Lambalk, Rene Eijkemans, Birgitta K. Velthuis, Joop S.E. Laven, Bart C.J.M. Fauser, Sara Baart, Laura Brouwers, Suzanne Cannegieter, Veerle Dam, Nadine Daan, Rene EijkemansMichel Ferrari, Christianne de Groot, Annemieke Hoek, Erik Koffijberg, Wendy Koster, Mark Kruit, Giske Lagerweij, Nils Lambalk, Katie Linstra, Aad van der Lugt, Antoinette Maassen van den Brink, Saskia Middeldorp, Karel Moons, Jeanine Roeters van Lennep, Jolien Roos-Hesselink, Luuk Scheres, Yvonne van der Schouw, Eric Steegers, Regine Steegers, Gisela Terwindt, Marieke Wermer, Bart Zick, Gerbrand Zoet,

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objective: Women with premature ovarian insufficiency (POI) enter menopause before age 40. Early menopause was associated with increased risk for coronary artery disease (CAD), death from cardiovascular disease and all-cause mortality. We compared the prevalence of CAD between middle-aged women on average 10 years following the initial POI diagnosis, with a population-based cohort. Design: Cross-sectional case-control study. Participants: Women from two Dutch University Medical Centers above 45 years of age previously diagnosed with POI (n = 98) were selected and compared with age- and race-matched controls from the Multi-Ethnic Study of Atherosclerosis (MESA). Measurements: The primary outcome was detectable coronary artery calcium (CAC) determined by coronary computed tomography (CCT). Results: Women with POI had significantly higher blood pressure, cholesterol and glucose, despite lower BMI compared to controls. Similar proportions of detectable CAC (CAC score >0 Agatston Units) were observed in women with POI and controls (POI n = 16 (16%), controls n = 52 (18%), P = 0.40 and P_adj = 0.93). In women with POI separately, we were not able to identify associations between CVD risk factors and CAC. The following CVD risk factors in controls were positively associated with CAC: age, diabetes mellitus, hypertension and LDL cholesterol. HRT use was negatively associated with CAC in controls. Conclusions: The presence of CAC did not differ significantly in women with POI around 50 years of age, compared to an age- and race-matched control group. We observe no increased calcified coronary disease in POI patients, despite the presence of unfavourable cardiovascular risk factors in these women.

Original language	English
Pages (from-to)	314-322
Number of pages	9
Journal	Clinical Endocrinology
Volume	91
Issue number	2
DOIs	https://doi.org/10.1111/cen.14003
Publication status	Published - 1 Aug 2019

Keywords

cardiovascular
coronary artery calcium score
menopause
POI
reproductive disorder
risk factor
Humans
Middle Aged
Case-Control Studies
Calcinosis/complications
Female
Aged
Coronary Vessels/pathology
Primary Ovarian Insufficiency/complications

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10.1111/cen.14003

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Gunning, M. N., Meun, C., van Rijn, B. B., Maas, A. H. E. M., Benschop, L., Franx, A., Boersma, E., Budde, R. P. J., Appelman, Y., Lambalk, C. B., Eijkemans, R., Velthuis, B. K., Laven, J. S. E., Fauser, B. C. J. M., Baart, S., Brouwers, L., Cannegieter, S., Dam, V., Daan, N. (2019). Coronary artery calcification in middle-aged women with premature ovarian insufficiency. Clinical Endocrinology, 91(2), 314-322. https://doi.org/10.1111/cen.14003

@article{bc9f03b2063440c081a899e61ba6681e,

title = "Coronary artery calcification in middle-aged women with premature ovarian insufficiency",

abstract = "Objective: Women with premature ovarian insufficiency (POI) enter menopause before age 40. Early menopause was associated with increased risk for coronary artery disease (CAD), death from cardiovascular disease and all-cause mortality. We compared the prevalence of CAD between middle-aged women on average 10 years following the initial POI diagnosis, with a population-based cohort. Design: Cross-sectional case-control study. Participants: Women from two Dutch University Medical Centers above 45 years of age previously diagnosed with POI (n = 98) were selected and compared with age- and race-matched controls from the Multi-Ethnic Study of Atherosclerosis (MESA). Measurements: The primary outcome was detectable coronary artery calcium (CAC) determined by coronary computed tomography (CCT). Results: Women with POI had significantly higher blood pressure, cholesterol and glucose, despite lower BMI compared to controls. Similar proportions of detectable CAC (CAC score >0 Agatston Units) were observed in women with POI and controls (POI n = 16 (16%), controls n = 52 (18%), P = 0.40 and Padj = 0.93). In women with POI separately, we were not able to identify associations between CVD risk factors and CAC. The following CVD risk factors in controls were positively associated with CAC: age, diabetes mellitus, hypertension and LDL cholesterol. HRT use was negatively associated with CAC in controls. Conclusions: The presence of CAC did not differ significantly in women with POI around 50 years of age, compared to an age- and race-matched control group. We observe no increased calcified coronary disease in POI patients, despite the presence of unfavourable cardiovascular risk factors in these women.",

keywords = "cardiovascular, coronary artery calcium score, menopause, POI, reproductive disorder, risk factor, Humans, Middle Aged, Case-Control Studies, Calcinosis/complications, Female, Aged, Coronary Vessels/pathology, Primary Ovarian Insufficiency/complications",

author = "Gunning, {Marlise N.} and Cindy Meun and {van Rijn}, {Bas B.} and Maas, {Angela H.E.M.} and Laura Benschop and Arie Franx and Eric Boersma and Budde, {Ricardo P.J.} and Yolande Appelman and Lambalk, {Cornelis B.} and Rene Eijkemans and Velthuis, {Birgitta K.} and Laven, {Joop S.E.} and Fauser, {Bart C.J.M.} and Sara Baart and Laura Brouwers and Suzanne Cannegieter and Veerle Dam and Nadine Daan and Rene Eijkemans and Michel Ferrari and {de Groot}, Christianne and Annemieke Hoek and Erik Koffijberg and Wendy Koster and Mark Kruit and Giske Lagerweij and Nils Lambalk and Katie Linstra and {van der Lugt}, Aad and {van den Brink}, {Antoinette Maassen} and Saskia Middeldorp and Karel Moons and {van Lennep}, {Jeanine Roeters} and Jolien Roos-Hesselink and Luuk Scheres and {van der Schouw}, Yvonne and Eric Steegers and Regine Steegers and Gisela Terwindt and Marieke Wermer and Bart Zick and Gerbrand Zoet",

note = "Funding Information: The CREW‐IMAGO study is funded by the Dutch Heart Foundation (Grant number 2013 T083). The Dutch Heart Foundation had no role in study design and is neither involved in collection, analysis and interpretation of data nor in writing the manuscript. Funding Information: The current study was funded by the Dutch Heart Foundation, grant number 2013T083 (MNG, CM, LB). AF received fees and grant sup‐ port from the following organizations (in alphabetic order): Dutch Heart Foundation (Hartstichting), Dutch Medical Research Counsel (ZonMW), Ferring, Leading the Change, Danone. BCJMF has re‐ ceived fees and grant support from the following organizations (in alphabetic order): Abbott, Controversies in Obstetrics & Gynecology (COGI), Dutch Heart Foundation (Hartstichting), Dutch Medical Research Counsel (ZonMW), Ferring, London Womens Clinic (LWC), Menogenix, Myovant, OvaScience, Pantarhei Bioscience, PregLem/ Gedeon Richter, Reproductive Biomedicine Online (RBMO), Teva/ Theramex, World Health Organization (WHO). JSEL has received fees and grant support from the following organizations (in alpha‐ betic order): Danone, Dutch Heart Foundation, Euroscreen, Ferring, Roche, Titus Healthcare and ZonMW. CBL has over the most recent 5‐year period received fees and grant support from the following or‐ ganizations (in alphabetic order): Amsterdam UMC, Ferring, Merck and ZonMW. AHEMM, BKV, EB, RPJB, YA, MJCE and BBR have nothing to disclose. Authors declare complete independence from funders. Funding Information: Funding information The CREW-IMAGO study is funded by the Dutch Heart Foundation (Grant number 2013 T083). The Dutch Heart Foundation had no role in study design and is neither involved in collection, analysis and interpretation of data nor in writing the manuscript. Hereby, we would like to thank the CREW consortium for their effort in the Cardiovascular Risk Profile: Imaging and Gender-Specific Disorders. We thank Dr. G.A. Zoet in particular for his pioneering work for the CREW consortium. Publisher Copyright: {\textcopyright} 2019 John Wiley & Sons Ltd",

year = "2019",

month = aug,

day = "1",

doi = "10.1111/cen.14003",

language = "English",

volume = "91",

pages = "314--322",

journal = "Clinical Endocrinology",

issn = "0300-0664",

publisher = "Wiley-Blackwell",

number = "2",

}

Gunning, MN, Meun, C, van Rijn, BB, Maas, AHEM, Benschop, L, Franx, A, Boersma, E, Budde, RPJ, Appelman, Y, Lambalk, CB, Eijkemans, R, Velthuis, BK, Laven, JSE, Fauser, BCJM, Baart, S, Brouwers, L, Cannegieter, S, Dam, V, Daan, N, Eijkemans, R, Ferrari, M, de Groot, C, Hoek, A, Koffijberg, E, Koster, W, Kruit, M, Lagerweij, G, Lambalk, N, Linstra, K, van der Lugt, A, van den Brink, AM, Middeldorp, S, Moons, K, van Lennep, JR, Roos-Hesselink, J, Scheres, L, van der Schouw, Y, Steegers, E, Steegers, R, Terwindt, G, Wermer, M, Zick, B, Zoet, G 2019, 'Coronary artery calcification in middle-aged women with premature ovarian insufficiency', Clinical Endocrinology, vol. 91, no. 2, pp. 314-322. https://doi.org/10.1111/cen.14003

TY - JOUR

T1 - Coronary artery calcification in middle-aged women with premature ovarian insufficiency

AU - Gunning, Marlise N.

AU - Meun, Cindy

AU - van Rijn, Bas B.

AU - Maas, Angela H.E.M.

AU - Benschop, Laura

AU - Franx, Arie

AU - Boersma, Eric

AU - Budde, Ricardo P.J.

AU - Appelman, Yolande

AU - Lambalk, Cornelis B.

AU - Eijkemans, Rene

AU - Velthuis, Birgitta K.

AU - Laven, Joop S.E.

AU - Fauser, Bart C.J.M.

AU - Baart, Sara

AU - Brouwers, Laura

AU - Cannegieter, Suzanne

AU - Dam, Veerle

AU - Daan, Nadine

AU - Eijkemans, Rene

AU - Ferrari, Michel

AU - de Groot, Christianne

AU - Hoek, Annemieke

AU - Koffijberg, Erik

AU - Koster, Wendy

AU - Kruit, Mark

AU - Lagerweij, Giske

AU - Lambalk, Nils

AU - Linstra, Katie

AU - van der Lugt, Aad

AU - van den Brink, Antoinette Maassen

AU - Middeldorp, Saskia

AU - Moons, Karel

AU - van Lennep, Jeanine Roeters

AU - Roos-Hesselink, Jolien

AU - Scheres, Luuk

AU - van der Schouw, Yvonne

AU - Steegers, Eric

AU - Steegers, Regine

AU - Terwindt, Gisela

AU - Wermer, Marieke

AU - Zick, Bart

AU - Zoet, Gerbrand

N1 - Funding Information: The CREW‐IMAGO study is funded by the Dutch Heart Foundation (Grant number 2013 T083). The Dutch Heart Foundation had no role in study design and is neither involved in collection, analysis and interpretation of data nor in writing the manuscript. Funding Information: The current study was funded by the Dutch Heart Foundation, grant number 2013T083 (MNG, CM, LB). AF received fees and grant sup‐ port from the following organizations (in alphabetic order): Dutch Heart Foundation (Hartstichting), Dutch Medical Research Counsel (ZonMW), Ferring, Leading the Change, Danone. BCJMF has re‐ ceived fees and grant support from the following organizations (in alphabetic order): Abbott, Controversies in Obstetrics & Gynecology (COGI), Dutch Heart Foundation (Hartstichting), Dutch Medical Research Counsel (ZonMW), Ferring, London Womens Clinic (LWC), Menogenix, Myovant, OvaScience, Pantarhei Bioscience, PregLem/ Gedeon Richter, Reproductive Biomedicine Online (RBMO), Teva/ Theramex, World Health Organization (WHO). JSEL has received fees and grant support from the following organizations (in alpha‐ betic order): Danone, Dutch Heart Foundation, Euroscreen, Ferring, Roche, Titus Healthcare and ZonMW. CBL has over the most recent 5‐year period received fees and grant support from the following or‐ ganizations (in alphabetic order): Amsterdam UMC, Ferring, Merck and ZonMW. AHEMM, BKV, EB, RPJB, YA, MJCE and BBR have nothing to disclose. Authors declare complete independence from funders. Funding Information: Funding information The CREW-IMAGO study is funded by the Dutch Heart Foundation (Grant number 2013 T083). The Dutch Heart Foundation had no role in study design and is neither involved in collection, analysis and interpretation of data nor in writing the manuscript. Hereby, we would like to thank the CREW consortium for their effort in the Cardiovascular Risk Profile: Imaging and Gender-Specific Disorders. We thank Dr. G.A. Zoet in particular for his pioneering work for the CREW consortium. Publisher Copyright: © 2019 John Wiley & Sons Ltd

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Objective: Women with premature ovarian insufficiency (POI) enter menopause before age 40. Early menopause was associated with increased risk for coronary artery disease (CAD), death from cardiovascular disease and all-cause mortality. We compared the prevalence of CAD between middle-aged women on average 10 years following the initial POI diagnosis, with a population-based cohort. Design: Cross-sectional case-control study. Participants: Women from two Dutch University Medical Centers above 45 years of age previously diagnosed with POI (n = 98) were selected and compared with age- and race-matched controls from the Multi-Ethnic Study of Atherosclerosis (MESA). Measurements: The primary outcome was detectable coronary artery calcium (CAC) determined by coronary computed tomography (CCT). Results: Women with POI had significantly higher blood pressure, cholesterol and glucose, despite lower BMI compared to controls. Similar proportions of detectable CAC (CAC score >0 Agatston Units) were observed in women with POI and controls (POI n = 16 (16%), controls n = 52 (18%), P = 0.40 and Padj = 0.93). In women with POI separately, we were not able to identify associations between CVD risk factors and CAC. The following CVD risk factors in controls were positively associated with CAC: age, diabetes mellitus, hypertension and LDL cholesterol. HRT use was negatively associated with CAC in controls. Conclusions: The presence of CAC did not differ significantly in women with POI around 50 years of age, compared to an age- and race-matched control group. We observe no increased calcified coronary disease in POI patients, despite the presence of unfavourable cardiovascular risk factors in these women.

AB - Objective: Women with premature ovarian insufficiency (POI) enter menopause before age 40. Early menopause was associated with increased risk for coronary artery disease (CAD), death from cardiovascular disease and all-cause mortality. We compared the prevalence of CAD between middle-aged women on average 10 years following the initial POI diagnosis, with a population-based cohort. Design: Cross-sectional case-control study. Participants: Women from two Dutch University Medical Centers above 45 years of age previously diagnosed with POI (n = 98) were selected and compared with age- and race-matched controls from the Multi-Ethnic Study of Atherosclerosis (MESA). Measurements: The primary outcome was detectable coronary artery calcium (CAC) determined by coronary computed tomography (CCT). Results: Women with POI had significantly higher blood pressure, cholesterol and glucose, despite lower BMI compared to controls. Similar proportions of detectable CAC (CAC score >0 Agatston Units) were observed in women with POI and controls (POI n = 16 (16%), controls n = 52 (18%), P = 0.40 and Padj = 0.93). In women with POI separately, we were not able to identify associations between CVD risk factors and CAC. The following CVD risk factors in controls were positively associated with CAC: age, diabetes mellitus, hypertension and LDL cholesterol. HRT use was negatively associated with CAC in controls. Conclusions: The presence of CAC did not differ significantly in women with POI around 50 years of age, compared to an age- and race-matched control group. We observe no increased calcified coronary disease in POI patients, despite the presence of unfavourable cardiovascular risk factors in these women.

KW - cardiovascular

KW - coronary artery calcium score

KW - menopause

KW - POI

KW - reproductive disorder

KW - risk factor

KW - Humans

KW - Middle Aged

KW - Case-Control Studies

KW - Calcinosis/complications

KW - Female

KW - Aged

KW - Coronary Vessels/pathology

KW - Primary Ovarian Insufficiency/complications

UR - http://www.scopus.com/inward/record.url?scp=85066878135&partnerID=8YFLogxK

U2 - 10.1111/cen.14003

DO - 10.1111/cen.14003

M3 - Article

C2 - 31049984

AN - SCOPUS:85066878135

SN - 0300-0664

VL - 91

SP - 314

EP - 322

JO - Clinical Endocrinology

JF - Clinical Endocrinology

IS - 2

ER -

Coronary artery calcification in middle-aged women with premature ovarian insufficiency

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