Coronary Risk Factors

August 15, 2011

Despite many recent advances in therapy, coronary artery disease (CAD) remains the major contributor to death and premature disability in developed countries. This condition accounts for one third of all deaths in women. Furthermore, it is predicted that cardiovascular disease (CvD), due mainly to atherosclerosis (disease of the arteries), will become the leading cause of total disease burden in the world by the year 2020. understanding the reasons for this increasing prevalence and studying methods for prevention of coronary artery disease is therefore of tremendous importance. Over the past several decades, we have learned a great deal about the process of atherosclerosis and now appreciate the concept of “coronary risk factors,” or factors that are associated with an increased likelihood of developing coronary artery disease. Much of our understanding of these factors comes from prospective, observational studies of large populations of patients such as the Framingham Heart Study and the Seven Countries Study. The Framingham Heart Study is particularly useful because, unlike many other older medical studies, it included women from its beginning in 1948.

There is a widely held misperception that coronary artery disease is mainly a disease of men and is a killer of men. In fact, cardiovascular disease is as likely a cause of death in women as men over their lifetime. This is particularly the case given the longer life expectancy of women in the United States. While it is true that premenopausal women have a lower risk of cardiovascular disease, it appears that women lag 10-15 years behind men with regard to risk of cardiovascular disease. After menopause, coronary risk accelerates in women and begins to approach that of men as age advances. The reasons for the “female advantage” remain unclear but cholesterol levels appear to play some role. After menopause, levels of high-density lipoproteins (HDL, the good cholesterol) begin to decline. Levels of low-density lipoproteins (LDL, harmful cholesterol), on the other hand, begin to rise and this rise is sustained at least to age 80. The changes in the lipid profile are not sufficient to fully explain the female-to-male advantage, however. Recent medical studies of the effects of postmenopausal estrogen therapy have yielded surprising results. While hormone replacement therapy (HRT) with estrogen has been shown to raise HDL and lower LDL, large medical studies have not demonstrated any protective role of HRT with regard to coronary artery disease events. The Heart and Estrogen/Progestin Replacement Study (HERS) was a large medical study that evaluated postmenopausal women with known coronary artery disease and another study, the Women’s Health Initiative, evaluated hormone replacement in predominantly healthy women. Not only was there no protective benefit to hormone replacement, but there appeared to be a trend toward increased coronary artery disease mortality. This appears to be particularly the case in the first years of therapy. At this point, there is a lack of evidence that HRT is useful to prevent coronary artery disease events.

SEE ALSO: Acute myocardial infarction, Cardiovascular disease, Cholesterol, Diabetes, Exercise, Hormone replacement therapy, Hypertension, Nutrition, Smoking

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Category: C, Coronary Risk Factor