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January 9, 1995

Risk Factors That Attenuate the Female Coronary Disease Advantage

Author Affiliations

From the Department of Medicine, Section of Preventive Medicine and Epidemiology, Evans Memorial Research Foundation, Boston (Mass) University School of Medicine; and the Framingham Study, Framingham, Mass.

Arch Intern Med. 1995;155(1):57-61. doi:10.1001/archinte.1995.00430010063008

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)