TYPE-A BEHAVIOR PATTERN, HEART-DISEASE RISK-FACTORS, AND ESTROGEN REPLACEMENT THERAPY IN POSTMENOPAUSAL WOMEN - THE RANCHO-BERNARDO-STUDY

Cardiovascular disease is the leading cause of death among older Ameri can women. Estrogen replacement therapy (ERT) appears to reduce the ri sk of heart disease. For nearly five decades, the Type A behavior patt ern (TABP) has been implicated in the cardiac morbidity and mortality of both men and women, but no studies have examined the use of replace ment estrogen or whether ifs association with heart disease risk facto rs is different in Type A versus Type B women. We examined the effects of ERT and TABP on heart disease risk factors in a large population-b ased sample. Subjects were 1070 postmenopausal women, aged 50-89 years , who had been participants in the Rancho Bernardo Study. At a clinic visit made during 1984-1987, TABP was assessed with the Bortner Rating Scale, and heart disease risk factors (total cholesterol, high-densit y and low-density lipoprotein (HDL and LDL), triglycerides, fasting an d postchallenge insulin and glucose, and blood pressure) were measured . Based on a median split (median = 154.0) of scores on the Bortner Ra ting Scale, 52% of these women were classified as Type A. Type A women were significantly younger than Rating women (mean = 68.4 versus 71.0 years, respectively). After adjustment for age, significantly more Ty pe A than Type B women were on ERT (35% versus 24.7%, p = 0.001). Anal yses stratified by TABP indicated that within the Type A group, curren t users of ERT had higher levels of HDL cholesterol (p) = 0.001) and l ower levels of LDL cholesterol (p < 0.01), fasting plasma glucose (p < 0.001), and fasting insulin (p < 0.01). Among Type B women, current u sers of ERT had higher levels of HDL cholesterol (p = 0.07) and trigly cerides (p < 0.01), lower levels of LDL cholesterol (p < 0.01), and lo wer systolic blood pressure (p < 0.05) but no significant differences in either fasting. or postchallenge levels of either plasma glucose or serum insulin (each p < 0.01). Results of this study suggest that ERT may be associated with significant differences in the heart disease r isk factor profile in Type A versus Type B women, and these difference s may favor Type A women.