The ascertainment and adjudication of primary and secondary outcomes for WHI have been described in detail previously (21 (
link)). In brief, OS study participants were contacted by mail annually to collect self-reported outcomes, as well as updated exposure data (15 (
link)). The adjudication of outcomes for all OS participants continued through August 2009, allowing for an average duration of follow-up for OS participants of 12 years (17 (
link)). The initial adjudication of outcomes was performed by a physician adjudicator at a local clinical center and consisted of a physician review of hospital discharge summaries, relevant diagnostic tests, and death certificates. Primary and safety outcomes were subsequently confirmed by central adjudication; a review of primary cardiovascular outcomes was performed by the WHI Cardiovascular Central Adjudication Committee (21 (
link)).
Outcomes for the current analysis were adjudicated total CVD (fatal and non-fatal) and three major types of CVD: CHD, heart failure, and stroke, occurring within 5 years of baseline. These comprised primary (CHD) or secondary (CVD, heart failure, and stroke) cardiovascular outcomes in the WHI CT and were also ascertained among OS participants; (21 (
link)) methods for ascertainment of these outcomes were therefore well documented and consistent across local clinical centers.
Cardiovascular outcomes were defined as in the WHI OS. Non-fatal CVD outcomes were defined as CHD, stroke, heart failure, peripheral vascular disease, angina, coronary artery bypass graft (CABG), coronary revascularization, and pulmonary embolism (21 (
link)). Fatal CVD outcomes were defined as death due to cerebrovascular, definite CHD, possible CHD, pulmonary embolism, other cardiovascular, or unknown cardiovascular causes.
The outcome of CHD in WHI OS participants was defined as hospitalized myocardial infarction (MI) (definite or probable) or coronary death (21 (
link)). Definite and probable MI events were identified by an algorithm comprising medical history data, electrocardiogram readings, and cardiac enzyme/troponin levels, as available (22 (
link)). Silent MI events were not ascertained in OS participants; therefore, silent MI was not considered as an outcome in this analysis. Fatal coronary outcomes comprised out-of-hospital as well as hospitalized deaths: coronary death was identified based on a physician review of medical records and death certificate data and was defined as death consistent with an underlying cause of death of CHD (21 (
link)).
Outcome of heart failure was defined as signs and symptoms of heart failure together with one of the following: pulmonary edema on X-ray; ventricular dilation/poor ventricular function; or physician diagnosis and treatment for heart failure. Stroke was defined as rupture or obstruction of the brain arterial system, resulting in rapid neurological deficit persisting for 24 h or more. Stroke outcome comprised stroke, hemorrhagic stroke, or cause of death reported as stroke. Heart failure and stroke not resulting in hospitalization were not considered as WHI outcomes (21 (
link)).
Wright C.E., Enquobahrie D.A., Prager S., Painter I., Kooperberg C., Wild R.A., Park K., Sealy-Jefferson S, & Kernic M.A. (2023). Pregnancy loss and risk of incident CVD within 5 years: Findings from the Women's Health Initiative. Frontiers in Cardiovascular Medicine, 10, 1108286.