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Risk Factors That Attenuate the Female Coronary Disease Advantage

Risk Factors That Attenuate the Female Coronary Disease Advantage Abstract Objective: To compare the coronary disease experience of men and women in a community setting. Design and Setting: Prospective cohort study. Patients: Long-term follow-up of a population-based sample of 5209 men and women. Results: Women outlive men and experience fewer cardiovascular events. By middle age, women lag 20 years behind men in the incidence of myocardial infarction, but the gap closes in the elderly, when cardiovascular disease becomes the leading cause of death in women as well as in men. Menopause promptly escalates coronary disease risk threefold and greatly erodes the advantage over men. Women and men share the same major risk factors for coronary disease, although women experience a lower absolute risk. However, high ratios of total/high-density lipoprotein cholesterol level ratios, left ventricular hypertrophy, and diabetes tend to eliminate the female advantage. Conclusion: Coronary disease is not a minor problem in women. Consequently, women should take vigorous preventive measures. There is a need for particular attention to glucose tolerance and blood lipid levels and a greater sense of urgency when hypertension progresses to left ventricular hypertrophy.(Arch Intern Med. 1995;155:57-61) References 1. Kannel WB. Contributions of the Framingham Study to conquest of coronary artery disease. Am J Cardiol . 1988;62:1109-1112.Crossref 2. Castell WP. Cardiovascular disease in women. Am J Obstet Gynecol . 1988; 158:1153-1160. 3. Cupples LA, D'Agostino RB, Kiely T. Some Risk Factors Related to the Annual Incidence of Cardiovascular Disease and Death: Framingham Study: 30-Year Follow-up . Washington, DC: US Dept of Commerce, National Technical Information Service; 1987. National Institutes of Health publication 87-2703. 4. Kannel WB, Hjortland MC, McNamara PM, Gordon T. Menopause and risk of cardiovascular disease: the Framingham Study. Ann Intern Med . 1976;85:447-452.Crossref 5. Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR. High density lipoprotein as a protective factor against coronary heart disease. Am J Med . 1977;62:707-714.Crossref 6. Kannel WB, McGee DL. Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham Study. Diabetes Care . 1979;2:120-126.Crossref 7. Kannel WB. Potency of cardiovascular risk factors as the basis for antihypertensive therapy. Eur Heart J . 1992;13( (suppl 6) ):30-42. 8. Anderson KM, Wilson PWF, Odell PM, Kannel WB. An updated coronary risk profile: a statement for health professionals. Circulation . 1991;83:356-362.Crossref 9. Feinlieb M, Gillum R. Coronary heart disease in the elderly: the magnitude of the problem in the United States in coronary heart disease in the elderly. In: Wenger NK, Furberg CD, Pitt E, eds. Coronary Heart Disease in the Elderly . New York, NY: Elsevier Science Publishing Co Inc; 1986:29-59. 10. Roussouw JF. Review of international trials. In: Program and abstracts of the NHLBI Conference on Cholesterol and Heart Disease in Older Persons and Women ; June 18-19, 1990; Bethesda, Md. 11. Ornish D, Brown SE, Scherovitz LW, et al. Can lifestyle changes reverse coronary heart disease? Lancet . 1990;336:129-133.Crossref 12. Kane JP, Malloy MJ, Porta TA, Phillips NR, Diehl JC, Havel RJ. Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens. JAMA . 1990;264:3007-3012.Crossref 13. Brensike JF, Levy RI, Kelsey SF, et al. Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: results of NHLBI type II coronary prevention study. Circulation . 1984;69:313-324.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Risk Factors That Attenuate the Female Coronary Disease Advantage

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430010063008
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To compare the coronary disease experience of men and women in a community setting. Design and Setting: Prospective cohort study. Patients: Long-term follow-up of a population-based sample of 5209 men and women. Results: Women outlive men and experience fewer cardiovascular events. By middle age, women lag 20 years behind men in the incidence of myocardial infarction, but the gap closes in the elderly, when cardiovascular disease becomes the leading cause of death in women as well as in men. Menopause promptly escalates coronary disease risk threefold and greatly erodes the advantage over men. Women and men share the same major risk factors for coronary disease, although women experience a lower absolute risk. However, high ratios of total/high-density lipoprotein cholesterol level ratios, left ventricular hypertrophy, and diabetes tend to eliminate the female advantage. Conclusion: Coronary disease is not a minor problem in women. Consequently, women should take vigorous preventive measures. There is a need for particular attention to glucose tolerance and blood lipid levels and a greater sense of urgency when hypertension progresses to left ventricular hypertrophy.(Arch Intern Med. 1995;155:57-61) References 1. Kannel WB. Contributions of the Framingham Study to conquest of coronary artery disease. Am J Cardiol . 1988;62:1109-1112.Crossref 2. Castell WP. Cardiovascular disease in women. Am J Obstet Gynecol . 1988; 158:1153-1160. 3. Cupples LA, D'Agostino RB, Kiely T. Some Risk Factors Related to the Annual Incidence of Cardiovascular Disease and Death: Framingham Study: 30-Year Follow-up . Washington, DC: US Dept of Commerce, National Technical Information Service; 1987. National Institutes of Health publication 87-2703. 4. Kannel WB, Hjortland MC, McNamara PM, Gordon T. Menopause and risk of cardiovascular disease: the Framingham Study. Ann Intern Med . 1976;85:447-452.Crossref 5. Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR. High density lipoprotein as a protective factor against coronary heart disease. Am J Med . 1977;62:707-714.Crossref 6. Kannel WB, McGee DL. Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham Study. Diabetes Care . 1979;2:120-126.Crossref 7. Kannel WB. Potency of cardiovascular risk factors as the basis for antihypertensive therapy. Eur Heart J . 1992;13( (suppl 6) ):30-42. 8. Anderson KM, Wilson PWF, Odell PM, Kannel WB. An updated coronary risk profile: a statement for health professionals. Circulation . 1991;83:356-362.Crossref 9. Feinlieb M, Gillum R. Coronary heart disease in the elderly: the magnitude of the problem in the United States in coronary heart disease in the elderly. In: Wenger NK, Furberg CD, Pitt E, eds. Coronary Heart Disease in the Elderly . New York, NY: Elsevier Science Publishing Co Inc; 1986:29-59. 10. Roussouw JF. Review of international trials. In: Program and abstracts of the NHLBI Conference on Cholesterol and Heart Disease in Older Persons and Women ; June 18-19, 1990; Bethesda, Md. 11. Ornish D, Brown SE, Scherovitz LW, et al. Can lifestyle changes reverse coronary heart disease? Lancet . 1990;336:129-133.Crossref 12. Kane JP, Malloy MJ, Porta TA, Phillips NR, Diehl JC, Havel RJ. Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens. JAMA . 1990;264:3007-3012.Crossref 13. Brensike JF, Levy RI, Kelsey SF, et al. Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: results of NHLBI type II coronary prevention study. Circulation . 1984;69:313-324.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 9, 1995

References