(Circulation. 1997;95:252-264.)
© 1997 American Heart Association, Inc.
Articles |
Sex Differences in Coronary Heart Disease
Why Are Women So Superior? The 1995 Ancel Keys Lecture
the Department of Family and Preventive Medicine, University of California, San Diego.
Key Words: sex • coronary disease • women • men • survival
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Introduction |
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It was a great privilege to be asked to give the 1995 Ancel Keys lecture, following five very distinguished colleagues [Geoffrey Rose, Henry Blackburn, Jeremiah Stamler, Fred Epstein, and William Kannel] and honoring Ancel Keys. It is difficult to imagine how little we would know about CHD without their contributions.
The subject of my lecture, "Why are women so superior with regard to coronary heart disease?," is surely one of the most interesting of all epidemiological questions. My intention is to illustrate methodological problems and review old and new provocative results, making inferences from a variety of disciplines. My focus is on the origin of the gender gap, not postmenopausal estrogen therapy. There will be no conclusions, only reconstruction. My lecture is outlined in Fig 1
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Sex Roles |
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Unhealthy Behaviors
For years it was thought that the excess male mortality was explained by unhealthy behaviors that were more socially acceptable for men than women. These behaviors might include cigarette smoking, heavy alcohol use, eating more red meat and fewer fruits and vegetables, and exposure to physical hazards. The usual view was that differences in behavior were more important determinants of the higher male mortality than inherent sex differences in physiology.1 More recently, studies adjusting for unhealthy behaviors show that they contribute to but do not fully explain the increased risk of CHD in men.2
Work Outside the Home
It was also a popular premise that men were harmed by the stresses of the workplace; women were apparently protected by being at home relaxing
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 S. Manzi Systemic lupus erythematosus: a model for atherogenesis? Rheumatology, April 1, 2000; 39(4): 353 - 359. [Full Text] [PDF]
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E. Stensland-Bugge, K. H. Bonaa, O. Joakimsen, and I. Njolstad Sex Differences in the Relationship of Risk Factors to Subclinical Carotid Atherosclerosis Measured 15 Years Later : The Tromso Study Stroke, March 1, 2000; 31(3): 574 - 581. [Abstract] [Full Text] [PDF]
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H. Teoh, A. Quan, and R. Y.K Man Acute impairment of relaxation by low levels of testosterone in porcine coronary arteries Cardiovasc Res, March 1, 2000; 45(4): 1010 - 1018. [Abstract] [Full Text] [PDF]
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Estrogen: Consequences and Implications of Human Mutations in Synthesis and Action J. Clin. Endocrinol. Metab., December 1, 1999; 84(12): 4677 - 4694. [Abstract] [Full Text]
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O. Joakimsen, K. H. Bonaa, E. Stensland-Bugge, and B. K. Jacobsen Age and Sex Differences in the Distribution and Ultrasound Morphology of Carotid Atherosclerosis : The Tromso Study Arterioscler Thromb Vasc Biol, December 1, 1999; 19(12): 3007 - 3013. [Abstract] [Full Text] [PDF]
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K. Andersen, L. J. Launer, M. E. Dewey, L. Letenneur, A. Ott, J. R. M. Copeland, J.-F. Dartigues, P. Kragh-Sorensen, M. Baldereschi, C. Brayne, et al. Gender differences in the incidence of AD and vascular dementia: The EURODEM Studies Neurology, December 1, 1999; 53(9): 1992 - 1992. [Abstract] [Full Text] [PDF]
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 D. D. SIN, F. FITZGERALD, J. D. PARKER, G. NEWTON, J. S. FLORAS, and T. D. BRADLEY Risk Factors for Central and Obstructive Sleep Apnea in 450 Men And Women with Congestive Heart Failure Am. J. Respir. Crit. Care Med., October 1, 1999; 160(4): 1101 - 1106. [Abstract] [Full Text]
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 M. E. Mendelsohn and R. H. Karas The Protective Effects of Estrogen on the Cardiovascular System N. Engl. J. Med., June 10, 1999; 340(23): 1801 - 1811. [Full Text] [PDF]
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 L A Fitzpatrick, M Ruan, J Anderson, T Moraghan, and V Miller Gender-related differences in vascular smooth muscle cell proliferation: implications for prevention of arteriosclerosis Lupus, June 1, 1999; 8(5): 397 - 401. [Abstract] [PDF]
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E. Barrett-Connor and C. Stuenkel Hormones and Heart Disease in Women: Heart and Estrogen/Progestin Replacement Study in Perspective J. Clin. Endocrinol. Metab., June 1, 1999; 84(6): 1848 - 1853. [Full Text]
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G. Gardner, C. L. Banka, K. A. Roberts, A. E. Mullick, and J. C. Rutledge Modified LDL–Mediated Increases in Endothelial Layer Permeability Are Attenuated With 17ß-Estradiol Arterioscler Thromb Vasc Biol, April 1, 1999; 19(4): 854 - 861. [Abstract] [Full Text] [PDF]
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H. Teoh, S. W.S. Leung, and R. Y.K. Man Short-term exposure to physiological levels of 17{beta}-estradiol enhances endothelium-independent relaxation in porcine coronary artery Cardiovasc Res, April 1, 1999; 42(1): 224 - 231. [Abstract] [Full Text] [PDF]
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M. L Kuroski de Bold Estrogen, natriuretic peptides and the renin-angiotensin system Cardiovasc Res, March 1, 1999; 41(3): 524 - 531. [Abstract] [Full Text] [PDF]
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 D. C. Schwenke, J. D. Wagner, and M. R. Adams In vitro lipid peroxidation of LDL from postmenopausal cynomolgus macaques treated with female hormones J. Lipid Res., February 1, 1999; 40(2): 235 - 244. [Abstract] [Full Text]
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C. S. Duvernoy, C. Meyer, V. Seifert-Klauss, F. Dayanikli, I. Matsunari, J. Rattenhuber, C. Hoss, H. Graeff, and M. Schwaiger Gender differences in myocardial blood flow dynamics: Lipid profile and hemodynamic effects J. Am. Coll. Cardiol., February 1, 1999; 33(2): 463 - 470. [Abstract] [Full Text] [PDF]
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