Well-Being and All-Cause Mortality in Aging Women in the Women's Health Initiative (WHI)

Abstract To study the relationship between well-being and all-cause mortality, we estimated mortality among women in four classes of well-being using the well-being profile from the Women’s Health Initiative Study (WHI). Demographic characteristics were self-reported at enrollment (1993-98). All-cause mortality included death from any cause between 2012-2020. We used logistic regression to examine all-cause mortality risk across the classes, using Class 4 (highest hedonic and eudaemonic well-being scores) as the referent, adjusting for age and race. Compared to Class 4, all other classes had higher age- and race-adjusted odds of death. Highest risks were in Class 1 women (OR=2.61; 95% CI: 2.46-2.76) and Class 3 women (OR=1.62; 95% CI: 1.55-1.68). Women in Class 4 had the lowest risk of all-cause mortality over an 18-year follow-up. These results confirm the utility of a profile of well-being for predicting all-cause mortality while preserving ability to identify the differences among well-being indicators across classes.

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Letter by Lehmann Regarding Articles “Electrocardiographic Abnormalities That Predict Coronary Heart Disease Events and Mortality in Postmenopausal Women: The Women’s Health Initiative” and “Electrocardiographic Predictors of Incident Congestive Heart Failure and All-Cause Mortality in Postmenopausal Women: the Women’s Health Initiative”

Circulation ◽

10.1161/circulationaha.106.622530 ◽

2006 ◽

Vol 113 (23) ◽

Author(s):

Michael H. Lehmann

Keyword(s):

Heart Failure ◽

Women’S Health ◽

Women's Health ◽

Postmenopausal Women ◽

Women's Health Initiative ◽

Women’S Health Initiative ◽

Health Initiative ◽

All Cause Mortality ◽

Electrocardiographic Abnormalities ◽

The Women’S Health Initiative

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Metabolomic profiles associated with all-cause mortality in the Women’s Health Initiative

International Journal of Epidemiology ◽

10.1093/ije/dyz211 ◽

2019 ◽

Vol 49 (1) ◽

pp. 289-300 ◽

Cited By ~ 2

Author(s):

Raji Balasubramanian ◽

Nina P Paynter ◽

Franco Giulianini ◽

JoAnn E Manson ◽

Yibai Zhao ◽

...

Keyword(s):

Women’S Health ◽

Women's Health ◽

Postmenopausal Women ◽

Median Time ◽

Time To Death ◽

Women's Health Initiative ◽

Women’S Health Initiative ◽

Health Initiative ◽

All Cause Mortality ◽

The Women’S Health Initiative

Abstract Background Metabolomics profiling has shown promise in elucidating the biological pathways underpinning mortality, but there are limited data in female populations. Methods We applied a liquid chromatography-tandem mass spectrometry metabolomics platform to EDTA-plasma to measure 470 metabolites at baseline in a discovery set of 943 postmenopausal women (including 417 incident deaths, median time to death of 10.6 years) with validation in an independent set of 1355 postmenopausal women (including 685 deaths, median time to death of 9.1 years) in the Women’s Health Initiative. Results Eight new metabolites were discovered to be associated with all-cause mortality. Findings included protective effects of increased levels of three amino acids (asparagine, homoarginine and tryptophan) and docosatrienoic acid; and detrimental effects of increased levels of C4-OH-carnitine, hexadecanedioate and two purine/pyrimidines (N2, N2-dimethylguanosine and N4-acetylcytidine). In addition, a set of nine previously published metabolite associations were replicated. A metabolite score comprising 17 metabolites was associated with mortality (P < 10–8) after adjustment for risk factors, with a hazard ratio of 1.95 (95% CI: 1.46–2.62) for women in the highest quartile compared with the lowest quartile of metabolite score. The score was robust among younger women and older women, for both cardiovascular and non-cardiovascular mortality, and associated with both early deaths (within the first 10 years of baseline) and later deaths. Conclusions Our study fills a gap in the literature by identifying eight novel metabolite associations with all-cause mortality in women, using a robust study design involving independent discovery and validation datasets.

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Insulin Resistance and Cancer-Specific and All-Cause Mortality in Postmenopausal Women: The Women’s Health Initiative

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djz069 ◽

2019 ◽

Vol 112 (2) ◽

pp. 170-178 ◽

Cited By ~ 2

Author(s):

Kathy Pan ◽

Rebecca A Nelson ◽

Jean Wactawski-Wende ◽

Delphine J Lee ◽

JoAnn E Manson ◽

...

Keyword(s):

Insulin Resistance ◽

Women’S Health ◽

Women's Health ◽

Postmenopausal Women ◽

Medical Record ◽

Women's Health Initiative ◽

Women’S Health Initiative ◽

Health Initiative ◽

All Cause Mortality ◽

The Women’S Health Initiative

Abstract Background Insulin resistance has been proposed as a mediator of the increased cancer incidence and mortality associated with obesity. However, prior studies included limited cancer deaths and had inconsistent findings. Therefore, we evaluated insulin resistance and cancer-specific and all-cause mortality in postmenopausal women participating in the Women’s Health Initiative (WHI). Methods Eligible were a subsample of 22 837 WHI participants aged 50–79 years enrolled at 40 US clinical centers from 1993 to 1998 who had baseline fasting glucose and insulin levels. Baseline insulin resistance was measured by the homeostasis model assessment of insulin resistance (HOMA-IR). Cancers were verified by central medical record review and deaths verified by medical record and death certificate review enhanced by National Death Index queries. Cox proportional hazards regression models were used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer-specific and all-cause mortality. All statistical tests were two-sided. Results During a median of 18.9 years of follow-up, 1820 cancer deaths and 7415 total deaths occurred. Higher HOMA-IR quartile was associated with higher cancer-specific mortality (Q4 vs Q1, HR = 1.26, 95% CI = 1.09 to 1.47; Ptrend = .003) and all-cause mortality (Q4 vs Q1, HR = 1.63, 95% CI = 1.51 to 1.76; Ptrend < .001). A sensitivity analysis for diabetes status did not change findings. Among women with body mass index less than 25 kg/m2, higher HOMA-IR quartile was associated with higher cancer mortality (Fine and Gray, P = .004). Conclusions High insulin resistance, as measured by HOMA-IR, identifies postmenopausal women at higher risk for cancer-specific and all-cause mortality who could potentially benefit from early intervention.

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