Sex discrimination in myocardial infarction, which leaves in its wake many more widows than widowers, has yet to be explained. Because this discrimination ceases after the menopause, it was only logical to assume that ovarian hormones exert a protective effect. However, plausible as this assumption may be, it was never proved, nor did it receive support from observations on men who were taking estrogens for reasons unrelated to vascular disease. Their susceptibility to coronary thrombosis has increased, as has the susceptibility to thromboembolism in some women taking estrogenic oral contraceptives.
While the role of ovarian hormones in protecting women from coronary heart disease had been awaiting clarification, some investigators turned their attention to another aspect of menarche—the natural "blood letting" of menstruation. Speculating that increased blood viscosity related to a high hematocrit may be a factor in coronary thrombosis, De Pasquale and Burch1 suggested that the low incidence of
Vaisrub S. Sex Determinants in Heart Disease. JAMA. 1977;237(5):477. doi:10.1001/jama.1977.03270320055028
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