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Objectives: To quantify the combined effects of systolic blood pressure (SBP) and cigarette smoking on incident coronary heart disease (CHD) in women. Methods: Overall, 86,338 women aged ≥40 years were enrolled in 1991. The follow-up evaluation was conducted in 1999–2000, with a response rate of 92.9%. Results: A total of 829 CHD events (fatal and nonfatal) were observed among the participants who were free of cardiovascular diseases (CVD) at baseline. Higher SBP was significantly associated with more risk of CHD in both nonsmokers and current smokers (all p < 0.0001 for linear trends). Comparing with never smoking, both low and high levels of cigarettes smoked per day (1–7, and ≥8 cigarettes per day) and pack-years (<10, and ≥10 pack-years) were associated with increased risk of CHD in those with normal and high SBP. The multivariate adjusted relative risks (RRs) of CHD were 2.54 (95% confidence interval [CI] 2.00-3.23), 1.28 (1.01-1.63), and 1.57 (1.33-1.86) for current smokers with high SBP, current smokers with normal SBP, and nonsmokers with high SBP, respectively, compared with nonsmokers with normal SBP. The present study identified a statistically significant additive interaction between these two factors on CHD. Conclusions: Our study indicated that the combined effects of cigarette smoking and high SBP could be expected to have extra adverse effects on CHD in women, which highlights the importance of multifactorial interventions to decrease the risk of CHD, for example, quitting smoking and treatment of high blood pressure in Chinese women. [ABSTRACT FROM AUTHOR]

Background: This study assessed the validity of several self-reported cardiovascular risk factors among low-income women aged 40–64 years in West Virginia. Methods: A cross-sectional survey was conducted of 733 women participating in the Well Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) project in West Virginia to examine agreement between self-report and clinical screenings in the prevalence of risk factors related to coronary heart disease (CHD). Women participating in the study were interviewed face-to-face before administration of clinical screenings that assessed height, weight, Quetelet's index, high blood pressure (systolic ≥140 mm Hg or diastolic ≥90 mm Hg), and elevated total cholesterol concentrations (≥200 mg/dL and ≥240 mg/dL). Results: The overall results showed high sensitivity and specificity for each of the risk factors examined; for overweight/obesity, the sensitivity was 96% and specificity was 93%; for cholesterol ≥240 mg/dL, sensitivity was 85% and specificity was 67%; for hypertension, sensitivity was 77% and specificity was 86%. Using a threshold value of ≥240 mg/dL for hypercholesterolemia led to higher sensitivity but a lower specificity than for a value of ≥200 mg/dL. Conclusions: This study found that among low-income women at higher risk for cardiovascular disease (CVD), self-reported values for high body mass index (BMI), hypercholesterolemia, and hypertension were well correlated with clinical measures, as indicated by high sensitivity values. Thus, self-reported values can be used for surveillance, targeted screenings, and health promotion activities, including lifestyle changes. [ABSTRACT FROM AUTHOR]

Background: Hypertension during pregnancy (HDP) increases the risk of future coronary heart disease (CHD), but it is unknown whether this association is mediated by renal injury. Reduced renal function is both a complication of HDP and a risk factor for CHD. Methods: Logistic regression models were fit to examine the association between a history of HDP and the presence and extent of coronary artery calcification (CAC), a measure of subclinical coronary artery atherosclerosis, in 498 women from the Epidemiology of Coronary Artery Calcification Study (mean age 63.3 ± 9.3 years). Results: Fifty-two (10.4%) women reported a history of HDP. After adjusting for age at time of study participation, HDP was associated with increased serum creatinine later in life ( p = 0.014). HDP was positively associated with the presence of CAC after adjusting for age at time of study participation (OR = 2.7, 95% CI 1.4-5.4). This association was slightly attenuated with adjustment for body size and blood pressure (OR = 2.4, 95% CI 1.2-4.9) but was not further attenuated with adjustment for serum creatinine and urinary albumin/creatinine ratio (OR = 2.6, 95% CI 1.3-5.3). Results were similar for CAC extent. Conclusions: HDP may increase a woman's risk of future CHD beyond traditional risk factors and renal function. Women with a history of HDP should be monitored for potential increased risk of CHD as they age. [ABSTRACT FROM AUTHOR]

Objective: It has been suggested that both endogenous reproductive hormones and hormone therapy may play a protective role against coronary artery disease (CAD). However, recent clinical trials have failed to demonstrate the benefit of a variety of forms of hormone therapy. The observational data on the role of endogenous reproductive hormones, using surrogate measures such as number of birth, age at menarche, and age at menopause are inconsistent. In addition, the longer-term associations have not been evaluated. The aim of this study was to evaluate the relationships between detailed measurements of endogenous and exogenous estrogen exposure time with angiographic CAD and major adverse cardiovascular events. Methods: We assessed total estrogen exposure time, quantitative CAD by a core angiography laboratory, and prospectively measured major adverse cardiovascular events in 646 postmenopausal women undergoing coronary angiography for evaluation for suspected ischemia in the Women's Ischemia Syndrome Evaluation (WISE) study. Results: Timing of postmenopausal exogenous hormone therapy (HT) use was associated with reduced CAD. Two summarized total estrogen time scores (TET and sTET) were not related to angiographic CAD after accounting for HT use. In addition, these scores were not related to cardiovascular events over a median of 6.0 years of follow-up. Conclusions: There was no independent relation of estrogen exposure time to angiographic CAD or major adverse cardiovascular events in a contemporary cohort of postmenopausal women evaluated for suspected ischemia. Our results suggest that the paradigm of estrogen protection from CAD in women may be more complex than estrogen exposure duration alone. [ABSTRACT FROM AUTHOR]

Background and Aims: The prognosis of female patients after acute coronary syndrome (ACS) has been shown to be inferior to that of male patients. Little is known about gender differences during the secondary prevention phase. Methods: After ACS, 117,913 patients (30.7% female) were enrolled in two large-scale German registries from 2000 to 2005 during phase II cardiac rehabilitation (CR). Demographic parameters, reperfusion strategies, cardiovascular risk factors, exercise capacity, and medication use at admission and discharge were assessed. Temporary changes (trends) and gender-specific differences were determined. Results: Compared to 2000, patients in 2005 were significantly older (females: 66.4 vs. 68.0 years; males: 62.3 vs. 63.3 years; p = 0.001) and had a higher body mass index (BMI) (females: 27.7 vs. 28.6 kg/m2; males: 27.6 vs. 28.1 kg/m2, in 2000 and 2005, respectively, p < 0.001). Target blood pressure <140/90 mm Hg at discharge was obtained in a smaller proportion of women than men (81.0 vs. 83.0%, p < 0.001). Low-density lipoprotein cholesterol (LDL-C) levels at discharge were significantly higher in female patients (95.0 vs. 93.2 mg/dL, p < 0.001); 80.9% of female vs. 83.8% of male patients achieved a target fasting glucose <126 mg/dL during the CR ( p < 0.001). Large between-center variability was noted for age, total cholesterol at entry, and exercise capacity at entry and discharge. Conclusions: Although control of cardiovascular risk factors has improved in both genders, over a recent 6-year period, female patients compared with males were less likely to achieve target values for blood pressure, fasting glucose, and lipid values in the early period after acute coronary events. [ABSTRACT FROM AUTHOR]

The article presents several abstracts of the articles, including "Hot flushes, coronary heart disease, and hormone therapy in postmenopausal women," by Huang AJ and Sawaya GF, "Meat intake and mortality: A prospective study of over half a million people," by Sinha R. and Cross AJ, and "Black cohosh hepatotoxicity: Quantitative causality evaluation in nine suspected cases," by Teschke R and Bahre R.

Background: Although extensive research has been conducted on both smoking and low exercise capacity alone, few studies have examined the joint impact or interaction of these two risk factors. We examined the joint and interactive effects of smoking and self-reported exercise capacity on subsequent clinical events (heart failure, myocardial infarction [MI], stroke, and cardiovascular-related mortality) among women with suspected myocardial ischemia. Methods: At baseline (1996–1999), 789 women completed angiographic testing of coronary artery disease (CAD) severity and provided self-report information about their smoking history and exercise capacity as well as demographic and other risk factor data. Incidence of clinical events among the women was tracked for a median of 5.9 years; this analysis was conducted in 2008. Results: In an adjusted survival analysis, women with a positive smoking history and self-reported low exercise capacity had the greatest risk of experiencing a clinical event (HR = 7.7, 95% CI 2.3, 25.5), followed by women with a positive smoking history and self-reported high exercise capacity (HR = 6.9, 95% CI 2.0, 24.6) and those with a negative smoking history and self-reported low exercise capacity (HR = 4.9, 95% CI 1.5, 15.8), relative to women with a negative smoking history and self-reported high exercise capacity. Additional analyses revealed a significant interaction between smoking history and exercise capacity, such that (1) women with a positive smoking history did not experience an additional significantly greater risk due to low exercise capacity, unlike those with a negative smoking history, and (2) all women experienced a significantly greater risk due to a positive smoking history regardless of their exercise capacity. Conclusions: Among women with suspected myocardial ischemia, the combined protective health effects of self-reported high exercise capacity and a negative smoking history remained significant after controlling for preexisting CAD severity and other established risk factors. These findings highlight the importance of studying behavioral risk factors in combination. [ABSTRACT FROM AUTHOR]

Background: Our objective was to examine differences in health-related quality of life (HRQOL) between people with coronary heart disease (CHD) and those without this condition in a population-based sample of U.S. adults and to examine the interaction between CHD and diabetes on HRQOL. Methods and Results: We performed a cross-sectional analysis of data from 50,573 participants aged ≥18 years from 10 states of the 2004 Behavioral Risk Factor Surveillance System (BRFSS). Data were self-reported. HRQOL was assessed with the Centers for Disease Control and Prevention (CDC) HRQOL-4 measures. After adjusting for age, gender, race or ethnicity, educational status, marital status, employment status, smoking status, body mass index (BMI), and alcohol use, the percentages of women without CHD who, during the previous 30 days, reported experiencing ≥14 physically unhealthy days, ≥14 mentally unhealthy days, and ≥14 activity-limitation days were 7.5%, 10.4%, and 3.6%, respectively, compared with 16.5% (odds ratio [OR] = 2.49, 95% confidence interval [CI] 2.02, 3.07), 14.5% (OR = 1.58, 95%, CI 1.22, 2.04), and 8.4% (OR = 2.56, 95% CI 1.98, 3.30) for women with CHD. The adjusted percentages of men without CHD who reported experiencing ≥14 physically unhealthy days, ≥14 mentally unhealthy days, and ≥14 activity-limitation days were 5.6%, 6.0%, and 3.0%, respectively, compared with 10.1% (OR = 1.85, 95% CI 1.47, 2.32), 8.7% (OR = 1.32, 95% CI 1.00, 1.74), and 6.4% (OR = 1.99, 95% CI 1.49, 2.66) for men with CHD. A higher adjusted percentage of women with CHD reported experiencing ≥14 physically unhealthy days ( p < 0.001) and ≥14 mentally unhealthy days ( p = 0.002) but not ≥14 activity-limitation days ( p = 0.090) than men with CHD. Conclusions: People with CHD have significantly impaired HRQOL compared with those without CHD. HRQOL among women with CHD is worse than that among men with CHD. [ABSTRACT FROM AUTHOR]

Background: The definition and prognostic utility of the metabolic syndrome remain controversial. Analyses in predominantly healthy populations suggest that the International Diabetes Federation (IDF) definition identifies more men with metabolic syndrome than the Adult Treatment Panel III (ATP III) criteria, with little difference among women. Whether the IDF definition identifies a greater prevalence of the metabolic syndrome than the ATP III definition in women with coronary artery disease (CAD) is unknown. Methods: We compared the prevalence and prognostic utility of both definitions of the metabolic syndrome in postmenopausal women with angiographic CAD enrolled in the Women's Angiographic Vitamin and Estrogen Trial (WAVE). We excluded 51 of 423 women enrolled (12%) who had missing data for components of the metabolic syndrome. Results: Mean age was 65.3 ± 8.4 years, 70% were white, mean body mass index (BMI) was 30.5 ± 6.0 kg/m2, mean waist circumference was 96.2 ± 12.9 cm, 89% had hypertension by history or elevated blood pressure, 58% had diabetes or hyperglycemia, 54% had low high-density lipoprotein cholesterol (HDL-C), and 44% had hypertriglyceridemia. Metabolic syndrome prevalence was 70% and 74% by ATP III and IDF criteria, respectively; 68% met criteria for both definitions. Classification between the two criteria was not affected by ethnicity or age. Incident cardiovascular events were similar in both metabolic syndrome classifications. Conclusions: Among postmenopausal women with angiographic CAD, the metabolic syndrome is very prevalent. The IDF modification of the ATP III definition only identifies a small additional number of women as having metabolic syndrome, independent of ethnicity or age, and provides little additional prognostic information. [ABSTRACT FROM AUTHOR]

Objectives: To examine cardiovascular disease (CVD) risk factors and changes in the 10-year coronary heart disease (CHD) risk factors in women who participated in the WISEWOMAN program in Nebraska. Methods: Data for analysis were available for a total of 10,739 women who received CVD screening between September 2002 and December 2004. We examined the relationships between sociodemographic characteristics and CVD risk factors, including high cholesterol, high blood pressure, high body mass index (BMI), and diabetes. Additionally, we assessed the 10-year CHD risk and the change in risk factors for CVD. Results: The incidence was 31 per 1000 for hyperglycemia, 66 per 1000 for hypertension, and 157 per 1000 for high cholesterol. The prevalence of obesity was 447 per 1000. Nonwhite, older, less educated, and rural women were more likely to be overweight or obese. Older, less educated, and overweight to obese women were more likely to have hyperglycemia and high blood pressure. Older and overweight to obese women were more likely to have high total cholesterol and an increased 10-year CHD risk. Conclusions: Race, age, and rural residence were related to CVD risk factors among low-income women in Nebraska. The effect of program eligibility requirements as a barrier to return visits should be more closely examined, and strategies to facilitate repeat screenings on WISEWOMAN projects should be undertaken. Additionally, women on the lower end of the socioeconomic spectrum were less likely to return for repeat visits, suggesting that further investigation is needed to understand why these women fail to return for screening services. [ABSTRACT FROM AUTHOR]

Aims: Low bone mineral density (BMD) has been shown to predict cardiovascular disease (CVD) and coronary heart disease (CHD) mortality in both women and men. The purpose of the current study was to determine whether a CHD risk assessment tool might be useful for identifying persons likely to have low BMD in a multiethnic population of women and men. Methods: Cross-sectional data for 3881 women and men aged 50–74 years without overt CHD or stroke from the Third National Health and Nutrition Examination Survey (NHANES III) were used to explore the relationship between BMD and 10-year CHD risk, as estimated using the Framingham CHD risk prediction algorithm, in gender-stratified multiple logistic regression models. Results: When compared with women who had a <10% CHD risk, women with a 10%–19% CHD risk were 45% more likely and those with a ≥20% CHD risk were 73% more likely to have low BMD. Similar increases in low BMD risk were not detected in men. Conclusions: In the United States, 10-year Framingham CHD risk assessment may be useful for identifying older women who should be evaluated for osteoporosis and referred for BMD measurement. The impact of such a screening strategy on fracture prevention needs further elucidation. [ABSTRACT FROM AUTHOR]

Background: Woman with heart disease may receive lower levels of clinical care than men. We assessed whether the Yentl syndrome (women receive equivalent care to men only when they demonstrate that they are like men by having a heart attack) operates in the management of angina pectoris in primary care. Methods: The study design is a cross-sectional survey of 1162 angina patients (552 women) managed in eight sentinel centers serving 15% of the population of Liverpool. Data were extracted by specially trained data managers. Analysis included directly age-standardized proportions and male/female adjusted odds ratios (AOR), adjusted for age, disease duration, physician consultation rate, and age at diagnosis. Results: All aspects of care were higher for men with angina-previous myocardial infarction (MI) than for women with angina-previous MI. Risk factor recording was an absolute 8% higher (95% CI 1%-17%), secondary prevention 9% higher (95% CI 1%-17%), cardiac investigation 10% higher (95% CI 1%-20%), and revascularization 13% higher (95% CI 4%-22%). Men with angina-previous MI consistently received the highest level and women with angina the lowest level of risk factor recording (AOR 1.79, 95% CI 1.21-2.66), secondary prevention (AOR 2.24, 95% CI 1.47-3.40), cardiac investigation (AOR 2.21, 95% CI 1.56-3.13), and revascularization (AOR 4.67, 95% CI 3.03-7.18). The provision of care to men with angina alone and women with angina-previous MI fell between these two extremes. Conclusions: A gender-based clinical hierarchy operates in the clinical management of angina pectoris in primary care. The Yentl syndrome did not apply, however, as women with angina received less intensive clinical care than similar men irrespective of prior MI. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to examine the association between the use of lipid-lowering medication and aggressive responding, hostility, cynicism, and depression scores in women undergoing coronary angiography. Methods: The cohort included 498 women from the National Heart, Lung and Blood Institute (NHLBI)-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. WISE is a four-center study of women with chest pain who underwent quantitative coronary angiography for suspected myocardial ischemia. The psychosocial indices included the Cook Medley Hostility questionnaire, measuring aggression, hostility, and cynicism, and the Beck Depression Inventory (BDI). Results: Compared to those not on lipid-lowering medication, women receiving lipid-lowering pharmacotherapy were older (62 vs. 55 years, p < 0.001) and had more hypertension, dyslipidemia, diabetes, and coronary artery disease (CAD, defined as 50 stenoses in at least one epicardial artery) (all p < 0.003). Women on lipid-lowering medication had higher aggressive responding scores than those not on medication, 3.0 1.8 vs. 2.7 1.7, respectively (age-adjusted p < 0.003). This association persisted after adjustment for coronary risk factors, education, and extent of angiographic disease (CAD) ( p < 0.005), and after exclusion of women using psychotropic medications ( p < 0.001). Hostility, cynicism, and depression scores did not differ by medication use. [ABSTRACT FROM AUTHOR]

Background: Work and marital status have been shown to be associated with health outcome in women. However, the effect of employment and marriage on psychosocial functioning has been studied predominantly in healthy subjects. We investigated whether work and marital status are associated with depressive symptoms, social support, and daily stress behavior in women with coronary artery disease (CAD). Methods: Data of 105 women with CAD and of working age were analyzed. General linear models were used to determine the association between work and marital status and depressive symptoms, social support, and daily stress behavior. Results: Women who were working at the time of measurement had lower levels of depressive symptoms (7.0 ± 1.2 vs. 12.1 ± 0.9, p < 0.01) and higher levels of social support (21.6 ± 1.0 vs. 18.9 ± 0.7, p = 0.03) than the nonworking women, whereas marital status was not related to any of the outcome variables. Results were similar after adjusting for potential confounders, that is, age, education, self-reported health, and risk factors for CAD. There was no significant interaction between marital status and working status on depressive symptoms, social support, or daily stress behavior. Conclusions: In women with CAD, all <65 years of age, after a cardiac event, patients working had lower levels of depressive symptoms and a better social integration than those not working, regardless of reason for being nonemployed. Daily stress behavior, depression, and social support did not differ between cohabiting and not cohabiting women. Future interventions should take into consideration that women with CAD who are unemployed may have a higher risk for depression and social isolation and, therefore, poor clinical outcomes. [ABSTRACT FROM AUTHOR]

The article offers medical news briefs in the U.S. It is stated that the consumption of whole-grain foods may protect against mortality from inflammation that is not associated with coronary heart disease or cancer in menopausal women. Meanwhile, genistein was proven to increase bone mineral density in postmenopausal women. Moreover, patients with depression and agitation associated with Alzheimer's disease can now be treated with omega-3 fatty-acid supplements.

Aims: Soy phytoestrogens are popular, but information on their coronary effects in patients with suspected ischemic heart disease is limited. Accordingly, we investigated the relationship between blood phytoestrogen levels and coronary reactivity in women with suspected myocardial ischemia referred for coronary angiography. Methods: Coronary flow velocity reserve (CFVR) and volumetric flow reserve (VFR) to adenosine (ADO) and nitroglycerin (NTG) (nonendothelial-dependent responses) and acetylcholine (ACH) (endothelial-dependent response) were assessed in 106 women from the Women's Ischemia Syndrome Evaluation (WISE). Blood phytoestrogen (daidzein and genistein) and estrogen (estradiol) levels were correlated with coronary reactivity measures. Results: Participants were mostly postmenopausal (79%), mean age 56 years, and 24% had obstructive coronary artery disease (CAD) at angiography. Genistein blood levels were negatively correlated with nonendothelial-dependent coronary flow responses. The highest genistein tertile (>6.1 ng/mL) had a CFVR of 2.1 ± 0.5 (mean ± SD) and VFRADO of 1.0 ± 0.6, and both were significantly ( p= 0.0001) lower compared with the other genistein tertiles combined. Similar associations were noted for CFVRNTG and VFRNTG ( p = 0.03 and p = 0.01, respectively). The highest genistein tertile was associated with lower CFVRACH compared with the other tertiles ( p = 0.03). In multivariable modeling, blood genistein levels were significant independent predictors of coronary flow responses to ADO. There were no significant correlations between coronary reactivity variables and daidzein or endogenous estrogen. Conclusions: In women with suspected myocardial ischemia, higher genistein blood levels are associated with impaired nonendothelial-dependent and endothelial-dependent coronary microvascular function. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the relationship of anger and hostility to angiographic coronary artery disease (CAD), symptoms, and functional status among women with suspected CAD. METHODS: Data were collected from 636 women with suspected CAD referred for diagnostic angiography in the Women's Ischemia Syndrome Evaluation (WISE) Study. CAD was assessed as angiographic presence/absence of disease (> or =50% stenosis in any epicardial coronary artery). Hostility/anger, angina, symptoms, and functional status were assessed by the Cook-Medley Hostility Inventory, Spielberger Anger Expression Scale, cardiovascular symptom history, and the Duke Activity Status Index. RESULTS: Logistic regression revealed that anger-out (i.e., aggressive behavior in response to angry feelings) was independently associated with the presence/absence of angiographic CAD (OR = 1.09, CI 1.01-1.17). Anger and hostility were higher among women reporting increased cardiovascular symptoms. In women without angiographic CAD, those with nonanginal cardiac symptoms had the highest anger-out, anger expression, hostile affect, and aggressive responding scores, and those with typical angina reported the lowest functional status. Among women with CAD, functional status was lowest in women with atypical angina. CONCLUSIONS: Among women with suspected CAD, anger-out scores were associated with the presence of angiographic CAD. Anger/hostility traits were associated with increased symptoms, particularly with nonanginal chest pain in women without angiographic CAD. Relationships among psychosocial factors, cardiac symptoms, and angiographic CAD are potentially important in the management of women with suspected CAD. [ABSTRACT FROM AUTHOR]

Background: There is much interest in promoting healthy heart awareness among women. However, little is known about the reasons behind the lower rates of heart disease among women compared with men, and why this risk difference diminishes with age. Previous comparative studies have generally had insufficient numbers of women to quantify such differences reliably. Methods: We carried out an individual participant data meta-analysis of 39 cohort studies (32 from Asian countries and 7 from Australia and New Zealand). Cox models were used to estimate hazard ratios (HR) for coronary death, comparing men to women. Further adjustments were made for several proven coronary risk factors to quantify their contributions to the sex differential. Sex interactions were tested for the same risk factors. Results: During 4 million person-years of follow-up, there were 1989 (926 female) deaths from coronary heart disease (CHD). The age-adjusted and study-adjusted male/female HR (95% confidence interval [95% CI]) was 2.05 (1.89-2.22). At baseline, 54% of men vs. 7% of women were current smokers; hence, adjustment for smoking explained the largest component (20%) of this HR. A significant sex interaction was observed between systolic blood pressure (SBP) and CHD mortality such that a 10 mm Hg increase was associated with a 15% greater increase in the relative risk (RR) of coronary death in women compared with men ( p = 0.002). Conclusions: Only a small amount of the sex differential in coronary death could be explained by differences in the prevalence of classic risk factors. Alternative explanations are required to explain the age-related attenuation of the sex difference in CHD risk. [ABSTRACT FROM AUTHOR]

Objective: Diabetes is associated with a higher coronary heart disease (CHD) mortality in women compared with men. Less aggressive control of the CHD risk factors in women can contribute to this excess mortality. Because hypertension has a high prevalence in subjects with diabetes, we compared the control of this risk factor between men and women. Methods: This was a retrospective cohort study comparing blood pressure levels and trends over a 1-year period between men and women with diabetes receiving primary care. Using a chronic disease registry database, subjects with type 1 and type 2 diabetes, aged ≥18, were identified for inclusion. Mean weighted systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated for subjects with multiple longitudinal readings. Subjects were classified into four blood pressure control categories based on the mean weighted blood pressure. Comparisons were made between men and women before and after controlling for baseline characteristics. Results: A total of 3181 subjects (46% women) were included in the study. More women than men were in the moderate and severely elevated blood pressure categories (40% and 6% compared with 32% and 5%, respectively, p < 0.001). The unadjusted mean SBP was 3 mm Hg higher in women (139 mm Hg in women compared with 136 in men, p < 0.001). These differences remained significant after controlling for baseline variables. Conclusions: In subjects with diabetes receiving medical care, women had poorer control of blood pressure and a significantly higher mean SBP compared with men. These findings might partially explain the excess CHD mortality in women with diabetes. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to evaluate the effect on insulin secretion and insulin sensitivity of hormone replacement therapy (HRT) with short-term unopposed transdermal 17β-estradiol and, after 1 year, when combined with intermittent medroxyprogesterone acetate (MPA). Methods: Ninety-nine postmenopausal women with coronary artery disease (CAD), but without diabetes mellitus, consecutively recruited from patients referred for invasive coronary investigations at a tertiary university clinic, were randomized to either HRT or a control group. Unopposed estradiol was given for 3 months, and MPA was added in cycles of 14 days every 3 months. Clinical investigations were undertaken at baseline and after 3 months and 12 months. Insulin sensitivity index (HOMA-IR) and insulin secretion (HOMA-BCF) were calculated using the homeostasis model assessment. Results: Compared with the control group, treatment with unopposed transdermal 17β-estradiol caused a significant decrease in HOMA-IR, that is, improved insulin sensitivity, but after combination with MPA and 12 months of HRT, no change was observed in HOMA-IR. Similarly, a transient decrease was observed for plasma levels of C peptide after unopposed 17β-estradiol. HOMA-BCF remained unchanged throughout the study period. Sex hormone-binding globulin (SHBG) was related to HOMA-IR but not to HOMA-BCF at baseline. The association with HOMA-IR grew stronger after unopposed transdermal estradiol. No deleterious effect of HRT on glucose metabolism was found in postmenopausal women with CAD. Conclusions: Short-term treatment with unopposed transdermal estradiol caused a decrease in insulin resistance, but long-term treatment after intermittent MPA was introduced had no effect on either insulin secretion or insulin resistance. [ABSTRACT FROM AUTHOR]

To understand when women's coronary heart disease (CHD) and CHD risk factorsare recognized prior to first myocardial infarction (MI).Medical record review of the 10 years prior to incident MI among women with aconfirmed incident MI between January 1, 1996, and December 31, 2001, to determine the timingof CHD diagnosis as well as assessment and treatment for risk factors.One hundred fifty women had incident MIs during the study period. They made8732 ambulatory visits and had 457 hospitalizations during the period of review (mean 9.1years, range 6.2–10 years). Average age at incident MI was 74.7 years (SD 12.6, range 38.9–99.8years). A CHD diagnosis prior to first MI was present in 52% (= 78) of the women but wasless common in those<70 years (= 0.001). All but 3 women had one or more modifiablerisk factors identified prior to their first MI. Treatment of recognized risk factors varied from81% (antihypertension medications) to only 28% (drug therapy for abnormal lipid levels).Having a diagnosis of CHD was associated with an increased likelihood of having identifiedrisk factors and receiving drug treatment for identified risk factors.Women with undiagnosed CHD (48%) and those with unrecognized or untreatedrisk factors for CHD, especially younger women, represent missed opportunities forprevention of cardiac events. [ABSTRACT FROM AUTHOR]

Background: Recent trials reveal no benefit and possible harm from chronic hormone replacement therapy (HRT). Less is known about intermediate-term outcomes associated with HRT use in the setting of acute coronary syndromes (ACS). Methods: To examine the prevalence of HRT use and relationships with intermediate-term outcomes among women with ACS, we classified as HRT users or nonusers 4029 postmenopausal women (age >50 years or postmenopausal by case report form) randomized in the Sibrafiban versus Aspirin to Yield Maximum Protection from Ischemic Heart Events Post-Acute Coronary Syndromes (SYMPHONY) and 2nd SYMPHONY trials. Outcomes included 90-day and 1-year death and 90-day stroke, death, or myocardial infarction (MI); death, MI, or stroke; and death, MI, or severe recurrent ischemia (SRI). Results: HRT use was 13% overall and varied by region (Asia, 0%; Eastern Europe, 0.2%; Latin America, 0.8%; Western Europe, 4%; Australia/New Zealand, 12%; Canada, 14%; United States, 24%); estrogen-only regimens were most common (90%). HRT users were younger, had higher estimated creatinine clearance, more frequently were smokers and had prior revascularization, but less frequently had diabetes, prior angina, or heart failure. Unadjusted 90-day and 1-year mortality rates were lower among HRT users (hazard ratios [95% CII 0.48 [0.230.981 and 0.35 [0.18-0.681, respectively) but after multivariable adjustment, were not significantly different. Ninety-day stroke and composite end points did not differ between HRT users and nonusers. Conclusions: HRT use (predominantly estrogen-only) was low among patients with ACS but varied by region and was not associated with improved intermediate-term outcomes. These results are consistent with the absence of benefit from HRT use (combination or estrogen only) in previous studies in more stable populations. [ABSTRACT FROM AUTHOR]

Background: We used the baseline data collected for the Well-integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) participants to provide a snapshot of cardiovascular disease (CVD) risk on enrollment and to address racial/ethnic disparities in the following CVD risk factors: body mass index (BMI), systolic and diastolic blood pressure, high-density lipoprotein (HDL) and total cholesterol, diabetes and smoking prevalence, 10-year coronary heart disease (CHD) risk, and treatment and awareness of high cholesterol, hypertension, and diabetes. Methods: We used linear regression analysis to (1) assess the presence of racial/ethnic disparities and test whether existing disparities can be explained by (2) differences in individual characteristics or by (3) differences in individual and community characteristics. Results: Our results reveal a high degree of CVD risk among the WISEWOMAN participants and statistically significant racial/ethnic disparities in risk factors. Black participants were at the greatest risk of CVD, and Hispanic and Alaska Native participants were healthier in terms of CVD risk than white participants. Some racial/ethnic disparities were explained by differences in individual and community characteristics, but other disparities persisted even after controlling for these factors. Conclusions: Because differences in community characteristics explain many of the racial/ethnic disparities in CVD risk factors, eliminating disparities may require community-wide interventions. Successful WISEWOMAN projects are likely to not only reduce CVD risk factors overall but also to lessen racial/ethnic disparities in these risk factors. [ABSTRACT FROM AUTHOR]

Presents summaries of studies on women's health. Effect of high-frequency vibration training exercise on muscle power; Menopausal status dependence of early mortality reduction due to smaller breast cancer diagnosis; Incidence of myocardial ischemia during postpartum hemorrhage; Cervical ripening with transcervical foley catheter and the risk of uterine rupture.

The aim of this study was to determine if the metabolic syndrome (MetS) or other risk factors might be common among young women with nonfatal myocardial infarction (MI). A matched case-control study using a structured interview and questionnaires, plus analysis of conventional and nonconventional risk factors for MI in serum or plasma was carried out at a teaching hospital. Subjects were 40 women with nonfatal MI at or before age 45 and an equal number of age-matched, ethnicity-matched, and smoking-matched female control subjects. Cases and control subjects were not significantly different with regard to serum or plasma levels of homocysteine, anticardiolipin antibodies, β2-glycoprotein I, prothrombin, folate, vitamin B12, high-sensitivity C-reactive protein (CPR), fibrinogen, amyloid A, plasminogen activator inhibitor type 1 (PAI-1), or tissue plasminogen activator (tPA) antigen levels. Compared with matched controls, cases had a higher rate of obesity (37% vs. 12%, p= 0.02), a higher proportion of fasting glucose ≥110 mg/dl (9% vs. 1%, p=0.01), and higher overall insulin resistance (27% vs. 5%, p=0.007). Type 2 diabetes tended to be more common in cases (17% vs. 5%, p=0.10). Cases were also more likely to be hypertensive (35% vs. 12%, p=0.04) and dyslipidemic (80% vs. 42%, p=<0.001) and to have higher triglyceride levels (110±13 mg/dl vs. 96±12, p=0.02). Overall, after controlling for weight, cases were 4.7 times more likely to have three or more diagnostic criteria of the MetS than matched controls: chisquare=7.2, OR=4.7, 95% CI (1.3, 25.3), p=0.008. Although this study may have been underpowered to recognize the contribution of other risk factors, we found that the dominant predictor of nonfatal MI in young women was the MetS. Screening young women with central obesity for other parameters of the MetS may help reduce the risk of MI at an early age. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the baseline health-related quality of life (HRQL) of 301 postmenopausal women with heart disease enrolled in the Estrogen Replacement and Atherosclerosis (ERA) trial. Methods: The primary measure of HRQL was the Medical Outcomes Study Short Form-36 (MOS SF-36). The SF-36 was augmented with secondary assessments, including measures of depressive symptoms, life satisfaction, urinary incontinence, sleep disturbance, and physical symptoms. Multiple regression analyses were used to test hypotheses regarding the contribution of positive (social support) and negative (social strain) aspects of social relations after accounting for other correlates of HRQL and heart disease. Results: Results indicate that social support was positively associated with better functioning for all measured outcomes (all p < 0.05) except symptom frequency and severity. Social strain was negatively associated with HRQL functioning (all p < 0.05) except overall physical functioning, sleep disturbance, and urinary incontinence. In addition, several comorbid conditions were negatively associated with HRQL outcomes. In particular, chest pain was significantly associated with worse functioning on all HRQL outcomes except urinary incontinence. Conclusions: These data suggest that both clinical status variables (particularly chest pain) and the psychosocial context (represented by dimensions of relationship quality) influenced HRQL in this cohort. Thus, interventions that combine medical treatments with psychosocially based interventions may be most effective for women at risk for impaired HRQL. [ABSTRACT FROM AUTHOR]

The recommendation has been made that all women be counseled about the risks and benefits of hormone replacement therapy (HRT). Use of HRT among women undergoing coronary angiography was explored to assess whether patterns of use were similar to data drawn from community samples. Using a descriptive design, a convenience sample of 414 postmenopausal women was interviewed. Fifty-eight percent had never used HRT, 18.3% were past users, and 23.7% were currently using HRT. The primary reason given for ever using HRT was for symptoms of menopause. Less than 14% of women cited coronary heart disease (CHD) or osteoporosis as their primary reason for using HRT. The most common reasons for stopping HRT were side effects and fear of cancer. The most common reasons given for never having used HRT were that their healthcare provider had never talked about it and that they had never thought about it. Use of HRT among women undergoing coronary angiography is similar to that found in community samples. The challenge is to promote patient-provider interactions that include information about HRT based on the scientific model as well as attention to women's individual concerns. [ABSTRACT FROM AUTHOR]

This nonexperimental two-by-two study was designed to determine whether a difference existed between postmenopausal women who underwent surgical menopause and those who experienced natural menopause and between those who were and those who were not taking hormone replacement therapy (HRT) on four dependent variables. Bandura's self-efficacy theory and Prochaska and DiClemente's transtheoretical model of change provided the framework. Subjects (n = 77) were recruited from one physician's practice at a metropolitan multi-specialty outpatient clinic. Instruments were the Demographic Data Form, Risk of Coronary Heart Disease Table, Food Habits Questionnaire, Stage of Change to Dietary Fat Reduction, and Self-Efficacy for Health-Related Diet Behaviors. The independent variables, type of menopause and hormone status, had two levels. The dependent variables were coronary heart disease (CHD) risk, dietary fat modification, stages of change, and self-efficacy. Two-way ANOVA were used to determine differences between the two independent variables on the dependent variables. Findings indicated that women who experienced natural menopause and were not on HRT were at greater risk for CHD than women who underwent surgical menopause, the majority of whom were on HRT. Those women with natural menopause had a greater risk of developing CHD over time than their counterparts. Significant findings indicated that women who experience natural menopause should receive education on the risks and benefits of HRT. Hopefully, this education will enhance their ability to make their choice wisely. [ABSTRACT FROM AUTHOR]

We explored the social and contextual etiology of coronary heart disease (CHD) prevention and management in women. Social and contextual influences on CHD risk include such factors as socioeconomic status, access to healthcare, cultural mores, working conditions including work overload, multiple role responsibilities, and social isolation. Women, particularly economically disadvantaged women, occupy lower levels on the social status hierarchy and, therefore, experience more stressful life experiences, less favorable living conditions, and less opportunity to affect positive health behavior and outcomes. Women are often discriminated against economically, politically, and socially, and this discrimination may adversely affect their efforts at CHD health promotion and treatment. Multiple role responsibilities within the family and psychosocial factors, including chronic life stress, are critical to an understanding of the health status of women, particularly poor and minority women. Although community-based interventions appear to be ideal for addressing the contextual risks related to CHD in women, a number of issues need to be considered, for example, the limited acknowledgment of secular trends in economic development that influence lifestyle decisions and health promotion efforts. Directions for research and interventions include recognition of the full spectrum of CHD risk in women, recognition of culturally competent interventions, and recognition of the need for empowerment of women. [ABSTRACT FROM AUTHOR]

Coronary heart disease (CHD) is the leading cause of death for women in the United States. There has been a substantial decrease in CHD mortality in the past few decades in the United States for both women and men. The change in lifestyle after World War II may affect the incidence of and mortality from CHD in a more recent birth cohort, such as the 45-54-year-old age group. CHD mortality among women aged 45-54 by state and race in the United States and other countries in 1994 was evaluated. Correlation of the CHD mortality with state-specific and race-specific educational attainment (% of not a high school graduate) and state-specific prevalence of smoking was examined. There was a 2.5-fold difference in CHD mortality (ICD 410-414, 429.2) between black and white women aged 45-54: 78/100,000 for black versus 31/100,000 for white women; a 3-fold difference in CHD mortality among white women by state: 16/100,000 in Colorado versus 53/100,000 in Louisiana; and a 3-fold difference in CHD mortality among black women by state: 45/100,000 in New Jersey versus 124/100,000 in Arkansas. CHD mortality was correlated with educational attainment among white women (r = 0.62, p = 0.001) and with prevalence of smoking (r = 0.39, p = 0.021). There is a large variation in CHD mortality among women aged 45-54 in the United States by race and state. These differences may reflect variations in coronary risk factors. More detailed evaluation of determinants of CHD mortality by area is needed, as are public health programs that can reduce the marked disparity in CHD mortality in the United States. [ABSTRACT FROM AUTHOR]

This review identifies coronary heart disease (CHD) as the leading cause of mortality among postmenopausal women and highlights the well-documented problem of underrecognition and undertreatment of women who are at risk for or who already have CHD. This undertreatment encompasses both preventive care (i.e., drug treatment for lipid management) and more invasive treatments (e.g., revascularization procedures). Preventive interventions to reduce dyslipidemia and control other coronary risk factors can lessen CHD mortality and morbidity in the postmenopausal woman. [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) continues to be a major cause of death in women, with increased incidence noted among women after menopause. Many younger women also develop CAD, and little is known about the experiences of these women. In this investigation, premenopausal women were recruited from a cardiac rehabilitation program in a large inner-city hospital. In-depth interviews were conducted with 11 younger women. Interviews were transcribed verbatim, and the computer program QSR NUD.IST TM was used to facilitate data analysis. Foci of analysis included risk factors, presenting signs and symptoms, and participants' experiences after their diagnosis with CAD. All participants had strong family histories of CAD. However, several believed they were safe until after menopause or were not at risk because of their gender. Although most participants experienced chest discomfort, often this was not the initial symptom. Participants discussed the effects of their illness on their lifestyle. Areas of concern included diet, exercise, careers, and relationships. Strategies for coping and adapting, as well as advice for other younger women newly diagnosed with CAD, were discussed. The diagnosis of CAD strongly and uniquely affects the lives of younger women. Understanding the unique experiences of younger women is essential to providing them with relevant healthcare as they recover from and learn to live with CAD. [ABSTRACT FROM AUTHOR]

The article focuses on lifestyle change in women with coronary heart disease (CHD). CHD is the leading cause of death in Western culture. The impact of the disease spreads beyond the suffering of an individual patient. Society also pays an enormous price. Traditional invasive approaches to treatment are expensive. Coronary artery bypass graft surgery, for instance, consumes more health dollars than any other medical procedure. Strategies to promote healthier lifestyles, rather than invasive surgical or medical procedures, hold promise for helping ease individual suffering while reducing the use of medical services and containing costs. Few studies, however, have related behavioral and psychosocial factors to lifestyle change or linked lifestyle change to coronary risk reduction. Rarer, still are studies relating lifestyle change specifically to CHD in women. Researchers increasingly are recognizing the need to take into account gender differences in the course of CHD. The article reviews what is known about psychosocial factors related to lifestyle change in women with heart disease. Because of the paucity of studies focused specifically on women, the review includes not only recent studies of CHD exclusively in women but also relevant studies of CHD that include men as well as women.

The article focuses on the importance of coronary risk factor assessment and the need for preventive interventions in women with coronary heart disease (CHD). CHD is the dominant cause of mortality among U.S. women, accounting for 250,000 deaths annually, about 22% of all deaths in women. Not only is CHD a highly lethal disease for women, but it is a substantial contributor to morbidity, disability, hospitalizations, and office visits as well. The prevalence of CHD among women rises steeply with increasing age. The high prevalence of coronary risk factors in middle-aged and elderly women of all racial and ethnic groups in the United States underscores the importance of their coronary risk factor assessment and the need for preventive interventions. The most cost-effective primary preventive approach involves the targeting of high-risk women for evaluation and the institution of preventive strategies. As is detailed. subsequently, high-risk categorization should include diabetic women (including those with gestational diabetes), those with high-density lipoprotein (HDL) cholesterol, those with low HDL and elevated triglyceride levels, and women with premature menopause without estrogen therapy.

Last month, the results of Heart and Estrogen/Progestin Replacement Study (HERS), the first large, randomized, secondary prevention trial of hormone replacement therapy (HRT) to prevent heart disease were announced and published. The results were surprising: there was no overall cardiovascular benefit to women with heart disease assigned to active hormone therapy. Headlines emphasized the null results as individuals in both the medical and lay communities struggled to understand how these findings could be so different from the large body of observational evidence showing a cardio-vascular benefit of estrogen therapy. With the formal analysis, Hers was a null study showing no effect of HRT on the risk of subsequent coronary disease in women with heart disease. HERS is a randomized clinical trial, which is the study design least likely to yield biased results. It has been suggested that the results of HERS (null) differ from the results of the observational studies because the observational studies are more likely to be biased, particularly by a healthy-user effect.

A proven strategy to reduce the risk for coronary morbidity and mortality is the reduction of elevated total and low-density lipoprotein cholesterol concentrations in at-risk individuals. However, data from the National Heart, Lung, and Blood Institute's 1995 Cholesterol Awareness Surveys indicate that only 29% of patients with coronary disease--the population in whom the greatest benefit has been shown--are currently receiving lipid-lowering therapy. One possible explanation for the undertreatment of women with lipid disorders is the paucity of data from large-scale clinical trials to support its use in women at risk for coronary heart disease (CHD). Traditionally, women were not included in trials because of their relatively low risk for developing symptomatic atherosclerotic disease before the onset of menopause, even though theft risk rises after menopause to a level comparable to that of age-matched men. This rationale explains in part why earlier prevention trials focused on middle-aged men, who were at greater shorts term risk for CHD.