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Q J Med 2000; 93: 135-145
© 2000 Association of Physicians

Reviews

Cardiovascular risk in women: the cardiologist's perspective

E. EDMUNDS and G.Y.H. LIP

From the University Department of Medicine and Department of Cardiology, City Hospital, Birmingham, UK


   Introduction
 
The incidence of coronary heart disease (CHD) is much lower in younger women than in age-matched men, and this has led to the popular misconception that cardiovascular disease is a disease of men, and is relatively rare in women. This, however, is not the case. The incidence of CHD may be much lower in young women than in men of the same age, up to the age of 65, with the risk of dying from CHD being 3.5-fold higher in men than in women. After age 65, however, the risk equalizes for both sexes.1 Overall, CHD is a very significant cause of morbidity and mortality amongst women.

The reasons for the lower incidence of CHD in younger women are unclear. Because of the increased incidence with age, it has been proposed that oestrogen may be responsible for the protective effects seen amongst younger women. Loss of this protection after menopause . . . [Full Text of this Article]


   From clinical trials to practice
 

   Evidence for the association between CHD and the menopause
 

   Possible mechanisms of oestrogen cardioprotection
 
Blood pressure and the menopause
Serum lipids and the menopause
Haemostatic variables and the menopause
Other cardiovascular risk factors and the menopause

   Possible mechanisms of cardioprotection with HRT
 
Oestrogen and lipids
HRT and blood pressure
Beneficial actions on the arterial walls and haemostasis
Diabetes and insulin sensitivity
Postmenopausal hormone replacement therapy and cardiovascular risk
Non-randomized, population-based studies
Randomized studies of the effects of HRT

   Conclusions
 

   Notes
 

   References
 

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P.B.S. Fowler, H. Tunstall-Pedoe, and E. Edmunds
Cardiovascular risk in women: the cardiologist's perspective
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