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Inflammatory And Hemostatic Biomarkers And Coronary Artery Calcification In Women Undergoing The Menopausal Transition

Wang, Norman C. (2014) Inflammatory And Hemostatic Biomarkers And Coronary Artery Calcification In Women Undergoing The Menopausal Transition. Master's Thesis, University of Pittsburgh. (Unpublished)

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Aims: Coronary heart disease (CHD) is a significant public health issue in the United States. The relationships of inflammatory and hemostatic biomarkers to subclinical CHD in women are uncertain. The aims of this study were to test the associations of baseline levels of four novel biomarkers with baseline coronary artery calcification (CAC) and CAC progression; and to evaluate if changes in these biomarkers were associated with CAC progression.
Methods: Subjects were obtained from the Study of Women’s Health Across the Nation Heart Study. C-reactive protein (CRP), fibrinogen, plasminogen-activator inhibitor type 1 (PAI-1), and tissue plasminogen activator antigen (tPA-ag) were log-transformed. Logistic regression was used for the categorical outcomes (presence of baseline CAC and CAC progression), and tobit and linear regression were used for the continuous outcomes (extent of baseline CAC and CAC progression, respectively). Univariable and multivariable analyses were performed.
Results: A total of 372 women with a mean age of 51.3 years (SD, 2.8) were included for the baseline CAC analyses of which 131 (35.2%) were black. In the univariable analyses, all novel biomarkers were positively associated with baseline CAC presence and extent (p<0.001). These were significant after adjusting for traditional risk factors, but not after adjusting for body mass index. A significant interaction of race on log(CRP) and CAC was present. In race-stratified multivariable analyses, log(CRP) was significantly associated with CAC presence and CAC extent in blacks, but not whites. There were 252 women for the CAC progression analyses. In the univariable analyses, log(PAI-1) and log(tPA-ag) were associated with presence of CAC progression and log(PAI-1) was associated with extent of CAC progression. After adjustment, only log(PAI-1) was associated with presence of CAC progression (OR, 1.91; 95% CI, 1.24- 2.93; p=0.003). There was a trend towards an association between log(PAI-1) and extent of CAC progression (p=0.06). Changes in biomarkers were not associated with CAC progression.
Conclusions: Inflammatory and hemostatic biomarkers are associated with baseline CAC through obesity, except for CRP and CAC in blacks. Log(PAI-1) is associated with presence of CAC progression. These findings may improve CHD prevention in midlife women.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Wang, Norman C.wangnc@upmc.eduNCW18
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorEl Khoudary, Samar
Committee MemberBarinas-Mitchell, Emmabarinas@edc.pitt.eduEJB4
Committee MemberChang, Chung-Chou H.changj@pitt.eduCHANGJ
Committee MemberMatthews, Karen A
Date: 29 January 2014
Date Type: Publication
Defense Date: 4 December 2013
Approval Date: 29 January 2014
Submission Date: 17 November 2013
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Number of Pages: 127
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: biomarkers, coronary artery calcification, menopause
Date Deposited: 29 Jan 2014 17:22
Last Modified: 19 Dec 2016 14:41


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