IMPACT OF THE MENOPAUSE ON THE EPIDEMIOLOGY AND RISK-FACTORS OF CORONARY-ARTERY HEART-DISEASE IN WOMEN

Cardiovascular disease is the leading cause of morbidity and mortality in women, and coronary artery heart disease (CHD) is the largest sing le component of fatal cardiovascular disease. Gender-related differenc es are observed in the symptomatology, natural course and outcome, and in the management of the acute coronary event. More women, compared t o men, have angina as their first manifestation of CHD, and they are l ess likely to have serious stenosis. Women undergo less invasive diagn ostic procedures, but have an overall prognosis that is worse than tha t of men. Rates of CHD in women increase after the fifth-sixth decades of life, suggesting that young women have a protective factor that is lost after the fifth decade. Because most women become menopausal dur ing this age range, it is speculated that the protective factor may th e female hormone, estrogen. This conclusion is supported by results of epidemiological studies indicating an increased risk of CHD in women with early-onset menopause and a reduced risk in postmenopausal women treated with estrogen replacement therapy. The impact of the menopausa l transition on other CHD risk factors is still not fully understood. Reduced estrogen levels resulting from the menopausal transition have been implicated in adverse effects on obesity and fat distribution, pl asma lipid profile, and theological properties of plasma and platelet function. Postmenopausal estrogen deficiency may also aggravate preexi sting diabetes mellitus and hypertension, and have an overall negative effect on the reaction to stress. These data suggest that estrogen de ficiency can directly and indirectly promote CHD in women. More resear ch is needed to clarify and differentiate menopause-related from aging -related effects on the risk of CHD women.