Coronary atherogenic risk factors in women

Cardiovascular disease, primarily coronary heart disease (CHD), remains the most frequent cause of death in Western industrialized nations: nearly one in every two deaths are currently attributable to CHD. Since the 1980s, gender-specific trends have become apparent in these statistics: whereas coronary–vascular mortality has appreciably decreased among men, women have conversely experienced a continuous rise in rates of death from CHD. In 1998 in Germany, for example, there were 94 700 deaths from coronary vascular disease among women (225·3 per 100 000), but only 84 015 among men (210·1 per 100 000). One explanation of this trend may lie in the fact that modern medicine over the past 30 to 40 years has considered CHD a ‘male disease’, and that classical epidemiological studies have consequently concentrated primarily on men. Fortunately for men, this phenomenon, its associated preventive measures, and improved therapeutic approaches have signified a decrease in mortality among men. The contrary development among females may be attributed to two factors: that insights gained in research for men are not automatically applicable to women, and/or that women less often enjoy application of advances in possibilities for diagnosis and therapy resulting from these insights. Since the 1980s, moreover, changes have taken place in the risk factor profile in women and men. Although the overall prevalence of risk factors such as hypertension, overweight, and smoking remains greater for men, the total increase in such risk factors has in recent decades been greater among women to a pronounced degree. This development has become especially apparent in smoking, which has increased among young women in contrast to a decreasing trend among men.