Copyright © 2003 by the European Society of Cardiology.
Letter to the Editor
Cardiovascular risk factors in women
Department of Epidemiology, K.U. Leuven, Leuven, Belgium
* Correspondence to: Prof. Dr H. Kesteloot, Department of Epidemiology, K.U. Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium. Tel: +32 16 336894; Fax: +32 16 336884
E-mail address: Hugo.Kesteloot{at}med.kuleuven.ac.be
Received 6 December 2002; accepted 5 July 2003
The study of coronary atherogenic risk factors and their consequences in women is interesting. The contention however that more women than men are dying from coronary heart disease (CHD) although correct, can be misleading.1At all ages, death from total cardiovascular disease (TCV) and CHD are markedly lower in women compared to men.2However CHD and TCV are more important as a cause of death at higher ages3and since women in Western countries live about 7 years longer than men, finally more women die from CHD. A caveat is due to the fact that the assumed causes of death, especially CHD at older ages, must be correct, which is unproven. In Table 1the correlation coefficient between all-cause (AC), TCV and CHD mortality between the sexes are given for 55 developed countries (list available). The correlation is high (all P<0.0001) but higher in the older age class. This shows that the causes of mortality are very similar, but not identical, between the sexes, and active at a lower level in women.4In Table 2the correlation coefficient between AC mortality and TCV and CHD mortality for men and women in the age class 55–64 years and 65–74 years are given for the same 55 countries. Again all correlations are high (P<0.0001) and highest in the oldest age class. Several large series of total cholesterol, HDL cholesterol, Apo A, and Apo B have been published for both sexes in the Eur Heart Journal. The influence of nutrition and alcohol, not mentioned by the authors, was clearly demonstrated. The authors also do mention that HDL cholesterol is about 0.25mmol/l higher in women than in men, but this is only true in Western populations. This is presumably due to an interaction between saturated fat and female hormone levels.5Table 3shows the mean male to female ratio of AC, TCV and IHD mortality rates. The ratio is higher in the younger age class. When TCV and IHD are expressed as a percentage of AC little difference between the sexes exist. The authors correctly pay attention to the sex differences of more recently defined risk factors, homocysteine, CRP, coagulation factors a.o. In view of the existing intersex correlations between AC, TCV and CHD mortalities one may presume that the differences will be qualitatively similar but quantitatively different. More studies in this field are certainly warranted.
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References
- Stangl V, Baumann G, Stangl K. Coronary atherogenic risk factors in women. Eur Heart J. 2002;23:1738–1752 doi: 10.1053/euhj.2002.3329.
[Free Full Text] - Sans S, Kesteloot H, Kromhout D. Theburden of cardiovascular disease mortality in Europe. Eur Heart J. 1997;18:1231–1248.
[Free Full Text] - Kesteloot H. Changing frequency of cardiovascular disease and cancer with age. Acta Cardiol. 2002;57:89–90.[Medline]
- Kesteloot H. Cardiovascular risk factors and mortality in women. Herz. 1987;12:248–254.[Medline]
- Kesteloot H, Sasaki S. On the relationship between nutrition, sex hormones and high-density lipoprotein in women. Acta Cardiol. 1993;48:355–363.[Medline]
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