Gonadal Function and the Development of Coronary Heart Disease

THERE IS an almost universal clinical impression that coronary heart disease and myocardial infaretion are more common in men than in women, particularly in the younger age groups. The over-all male-female ratios are commonly given as between 3 to 1 and 5 to 1, while in the under 40 age group, ratios between 15 to 1 and 30 to 1 have been reported. lA considerable body of evidence derived from animal and human studies suggests that estrogenic hormones may play a major role in retarding the development of coronary heart disease in young females.6 This concept has been greatly reinforced by the observations that serum lipid patterns and levels of serum cholesterol may be altered by the administration of estrogens.7-9 If functioning ovaries provide protection against coronary heart disease, a group of noneastrated women would be expected to develop less coronary heart disease than a castrated group. To test this hypothesis, the prevalerice of coronary heart disease was determnined for a group of bilaterally oophoreetomized women, representing castrates, and a group of hysterectomized women, representing noneastrates. Methods The primary comparisons made in this study are between a group of bilaterally oophorectomized women who had had surgical removal of both ovaries with or without hysterectomy and a group of hysterectomized women. In a later phase of the investigation a group of women with no history of major gynecologic surgery were also studied. These were sisters of women in the two primary groups.