Risk factors for coronary heart disease in women

Abstract

In the United States, coronary heart disease (CHD) is the leading cause of death in both women and men. Although advances in medical diagnosis and treatment of CHD have contributed significantly to the recent decline in CHD mortality, preventive measures--both lifestyle changes and improvements in the medical management of coronary risk factors--have been estimated to account for the majority of the secular decrease in heart disease mortality. Most of the modifiable risk factors for CHD and strategies for prevention of CHD are similar for both men and women. As reviewed in this article, however, the magnitude of the effect of some factors differs between men and women, and there are some risk factors as well as preventive interventions that are unique to women.

PIP: This article discusses the risk factors for coronary heart disease (CHD)--the leading cause of death in the US--in women. Studies have shown that cigarette smoking more than doubles CHD incidence and increases CHD mortality by 70%. A cohort study among more than 121,000 female nurses in the US revealed that the risk of CHD was 6 times greater in heavy smokers than nonsmokers. The level of blood cholesterol is also a strong risk factor for CHD: levels of high-density lipoprotein (HDL) cholesterol are inversely associated with the risk of CHD. Thus, lowering low-density lipoprotein (LDL) and increasing HDL cholesterol levels reduce CHD risk in both men and women. Hypertension is a risk factor which responds well to pharmacologic treatment, and increasing levels of physical activity were proven to decrease CHD risk in numerous studies. Meanwhile, obesity, which is prevalent in the US, worsens other coronary risk factors such as hypertension, diabetes, and hypercholesterolemia. A study showed that overweight women (body mass index values 29) are at 3 times the risk for CHD as those with body mass index values less than 21. Diabetes mellitus is another CHD risk factor which is stronger in women than in men, and CHD death rates are 3-7 times greater among diabetic than nondiabetic women. Other studies revealed that women who consumed alcohol in moderation (10-15 g of alcohol per day) had a 40% lower risk of CHD compared with nondrinkers. There is a significant relationship between combined oral contraceptive and cigarette use and increased risk of CHD. Estrogen replacement therapy, low-dose aspirin, and antioxidant vitamins have been proven in studies to reduce the risk of CHD in women.