Multiple risk prediction of myocardial infarction in women as compared with men.

Abstract

A study was undertaken to determine whether women who suffer a myocardial infarction in spite of the low frequency in this sex, are more heavily burdened by coronary riskfactors than other women The multivariate risk, based on cholesterol level, systolic blood pressure, and smoking habits, in the women with infarction was very similar to that in the men with myocardial infarction. There was no major difference in risk between pre-and postmenopausal women. A higher prevalence of diabetes mellitus in the women with infarction compared with the general population could not explain their increased risk for myocardial infarction. Thus, other factors must be operating in addition to the traditional risk factors.The incidence of myocardial infarction is higher in men than in women. From a Myocardial Infarction Register, we found the incidence to be about 6 times higher in men than in women in the age group 45 to 54 years (Elmfeldt et al., 1975a). The prevalence of angina pectoris as determined by a questionnaire was, however, similar in the two sexes (Bengtsson, 1969). Because of the low incidence of myocardial infarction in women, few population studies have been able to give an indication of prospective risk factors for this disease in women. In most communities, the only way of finding risk factors in women would be to perform well-designed case control studies.In the Framingham study (Kannel and Castelli, 1972), it was found that the same risk factors seem to operate in women as in men. It has been found that the mean age at the menopause was somewhat lower among women with myocardial infarction than among women in general population samples of similar age (Bengtsson, 1973;Kannel et al., 1975). In a report on myocardial infarction women several of the patients were still menstruating (Bengtsson, 1973), suggesting the protective effect Received for publication 14 April 1977 of the female hormone pattern can be nullified. A question of relevance in this connection is whether those women who suffer a myocardial infarct, but who are still menstruating, are more heavily burdened by coronary risk factors than other women and men of similar age.The present paper reports some data concerning multivariate risk prediction based on serum cholesterol level, systolic blood pressure, and smoking habits, with the aim of comparing the risk factor profile in the male and female population and in men and women who had suffered a myocardial infarct. Prospective data from a population study in men were available (Wilhelmsen et al., 1973).

Influence of the Menopause on Ischaemic Heart Disease and its Risk Factors and on Bone Mineral Content

“…In a study from Gothenburg (163) the prevalence of diabetes mellitus among women with myocardial infarction was found to be 15%, compared to 7 @ / 0 among men. In different population samples of men and women in Gothenburg diabetes was also found to be slightly but not significantly more prevalent in women than in men (163). As expected, an increasing prevalence of diabetes with advancing age was observed among the women in this study.…”

Smoking and Atherosclerotic Cardiovascular Disease in Men With Low Levels of Serum Cholesterol

“…Of these studies, virtually all were conducted in Western countries where the effects of serum cholesterol and smoking appear synergistic, at least in populations with high serum cholesterol levels. 16,17 In contrast, smoking was not an IHD risk factor in several observational studies conducted in populations with low serum cholesterol levels. In the Puerto Rico Heart Health Program, where the mean total cholesterol level was 5.22 mmol/L (202 mg/dL), smoking did not predict the occurrence of IHD.…”

Triglycerides and Cardiovascular Disease

“…Triglyceride has routinely been identified as a "risk factor" in case-control and angiographic studies, even after adjustment for total cholesterol (TC) or LDL-C [23][24][25][26][27][28][29][30][31][32][33][34] and HDL-C. 24,[27][28][29]33,34 In another case-control study, case subjects were 3-fold more likely to exhibit small, dense low-density lipoprotein (LDL) particles, referred to as the "pattern B" phenotype. 35 However, the triglyceride level explained most of the risk of the pattern B phenotype and was a stronger covariate than LDL-C, intermediate-density lipoprotein (IDL) cholesterol, or HDL-C.…”