Risk factors for coronary artery calcification

Posted July 30, 2020

The analysis of the relationship between individual risk factors and Coronary Artery Calcification (CAC) as markers of subclinical cardiovascular disease in midlife women is part of the third phase of a study supported by INCT. This population-based survey has been conducted for more than 20 years and has follows up a cohort of nearly 300 women living in the city of Passo Fundo, Rio Grande do Sul, Brazil.

The article “Risk factors associated with coronary artery calcification in midlife women: a population-based study” was published in Gynecological Endocrinology in 2019 and is authored by doctors Karen Oppermann, Veronica Colpani, and Poli Mara Spritzer.

In this phase, anthroprometric and metabolic data were assessed. Habitual physical activity was assessed by pedometer, a step-counter device. CAC was assessed by a multi-detector computed tomography system. Average Agatston score was used to stratify participants as CAC > 0 and CAC = 0.


According to Dr. Karen Oppermann, the research showed that women between 65 and 75 years old had an 80% increased risk of having a positive coronary calcium score compared with women between 45 and 55 years old. “Modifiable variables associated with coronary risk among midlife women from Passo Fundo were hypertension and abdominal fat deposition,” she explains.

The researcher details that calcium score levels, associated with other characteristics, will lead to a profile of greater cardiovascular risk. “Coronary risk is traditionally increased among smoker, dyslipidemic, hypertensive, and diabetic women,” states Dr. Oppermann. In the present study, hypertension and increased abdominal fat, as measured by waist circumference, were the variables associated with coronary calcium score.

Conversely, the use of hormone therapy for climacteric symptoms was shown to be associated with protection against coronary disease, i.e., women who were using hormones had a 50% lower risk of presenting with coronary calcium. “These results were controlled for each other and for other interfering variables,” comments the researcher.

Dr. Oppermann reminds that the use of hormone therapy in menopause should not be currently indicated with the sole objective of cardiovascular protection. However, the study shows that women who have been using HT for climacteric symptoms had a better clinical profile, including in terms of coronary calcium.

The study also shows that measures such as blood pressure control and abdominal fat reduction should be encouraged among midlife women to prevent coronary risk, as shown by lower calcium score.

First Phases

The women’s cohort has been followed for more than 20 years. The first interviews were conducted in the household of selected participants according to inclusion criteria.

According to Dr. Karen Oppermann, the first study was conducted from 1995 to1996 and was designed to investigate the prevalence of climacteric symptoms and menstruation disturbances among pre and perimenopausal women aged from 35 to 55 years old on that occasion.

In turn, the second phase of the research, conducted with the same participants, aimed to investigate variations in weight and body fat distribution, as well as the prevalence of psychoemotional disorders.

The third phase was designed to investigate cardiovascular risk factors, as well as physical activity profile, metabolic syndrome, coronary calcium score, and bone health.

Population Base

Since it is a population-base study, participants were drawn from IBGE’s census sector, within the entire urban perimeter of the city of Passo Fundo, which has currently 200 thousand inhabitants.

According to Dr. Karen Oppermann, investigations of this type allow results to be used in population similar to that of the original, both in the country and abroad. “Studies involving field research are time-consuming, but prevent inclusion biases, i.e., they are “real” studies, with women having several socioeconomic, educational, cultural levels, and with different behavioral and health profile”, she explains. “This epidemiologic design is fundamental for the establishment of public health measures,” she concludes.