Showing papers in "Illinois medical journal in 1954"

Coronary heart disease.

Abstract: Coronary heart disease (CHD) is a major contributor to disability and the single leading cause of death (nearly 2-fold greater than all other causes of death combined) among women in the United States. In 2001, 248,184 American women died from CHD. Even more disturbing, while the death rate from CHD in men has steadily declined during the last 20 years, it has remained relatively constant for women. Women are more likely than men to die within the first 12 months after a heart attack (38% compared with 25%), and 64% of women who died suddenly of CHD had no previous symptoms. Women also have high rates of disability after presenting with acute coronary disease. Within 6 years of a myocardial infarction (MI), 35% of women will have another MI, sudden cardiac death will claim the lives of 6%, and 46% will be disabled with heart failure. Although women and men share common clinical, environmental, and potentially genetic risk factors for CHD, the effects of different risk factors are different in men and women, thus, potentially modifying the impact of therapeutic and prevention strategies. Compared with men, women have a greater prevalence of several important CHD risk factors, including advanced age, hypertension, diabetes, and sedentary lifestyle. The impact of risk factors is disproportionate in women and men; for example, diabetes increases CHD risk 3–7 fold in women compared with 2–3 fold in men. Hormonal influences are clearly different between women and men. Coronary heart disease rates are lower in premenopausal women than in similarly aged men, and in women after menopause are 2–3 times those of women the same age who have not entered menopause. This change in the prevalence of coronary heart disease in women is not abrupt at menopause but rather a continuum of increasing risk over time (Figure 1). Further, a large body of observational data suggests an atheroprotective role of estrogen and combination hormone therapy (HT). More recently, randomized clinical trials of HT have completely reversed the understanding of the effects of HT on CHD events. This section will focus on summarizing the evidence of cardiac outcomes with HT as studied in randomized clinical trials. Recent meta-analyses support the individual trial results and also suggest that when observational studies are adjusted for socioeconomic status and other variables predictive of risk for cardiovascular disease, aggregate findings from observational studies are similar to those in randomized controlled trials.