Menopause, atherosclerosis, and coronary artery disease

Abstract

Women have coronary heart disease (CHD) later than men. This review describes studies of CHD risk factors or outcomes based on studies of premenopausal women followed through the menopause transition, and prospective cohort studies of younger or older women with CHD risk markers or disease outcomes in the context of their menopause history. Major early reports from both types of studies are included in order to put more recent work in context. Most attention has been paid to the Healthy Women Study (HWS), Study of Women's Health across the Nation (SWAN), the Nurses' Health Study (NHS), and the Rancho Bernardo Study (RBS) because they continue to produce recent publications designed to distinguish the effect of age from the effect of menopause. Understanding these differences has important implications for women's cardiovascular health, but remains incomplete. Transition studies have relatively short (<10 years) follow-up and exclude women with surgical menopause. Cohort studies suggest that women with oophorectomy are at greater risk for CHD than intact women, pointing to a greater risk from testosterone deficiency than from estradiol levels.

Figure 1

A. Total testosterone and 20-year incident CHD in women (adjusted for age, BMI, WHR, smoking, exercise, alcohol). B. Bioavailable testosterone and 20-year incident CHD in women (adjusted for age, BMI, WHR, smoking, exercise, alcohol) (Laughlin GA, Goodell V, Barrett-Connor E. Extremes of endogenous testosterone are associated with increased risk of incident coronary events in older women. J Clin Endocrinol Metab 2010;95:740–7, Copyright 2010, The Endocrine Society).