Skip to main content

Cardiovascular Risk in Postmenopausal Women: What is Known and what is Unknown

  • Conference paper
Hypertension in Postmenopausal Women

Abstract

The leading causes of death in postmenopausal women in the United States are coronary heart disease (CHD) and stroke, despite a steady decline during the past two decades [1, 2]. Cardiovascular disease (CVD) secondary to atherosclerosis occurs in much lower frequencies in many third world countries, as well as in several oriental populations [3]. The prevalence of CVD in premenopausal women is reflected by between a fifth and half as many deaths in CHD below the age of 50–55 years, as in men of the same age. After menopause, women develop CHD at the same rate as men, although approximately 6–10 years later [4]. The incidence of stroke is increased with age in both sexes, and most types of stroke are slightly more common in men than in women [5]. Despite the impact of CVD on postmenopausal womens’ health, very few population-based studies of CVD have included women, or focused exclusively on women. Furthermore, few clinical trials have involved female populations large enough to allow adequate evaluation of treatments for CVD in women [2].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Stampfer MJ, Colditz GA, Willet WC (1990) Menopause and heart disease. A review. Ann N Y Acad Sci 592: 193–203

    Article  CAS  Google Scholar 

  2. Bush T (1990) The epidemiology of cardiovascular disease in postmenopausal women. Ann NY Acad Sci 592: 263–271

    Article  PubMed  CAS  Google Scholar 

  3. Reeve J (1992) Future prospects for hormone replacement therapy. Br Med Bull 48: 458–468

    PubMed  CAS  Google Scholar 

  4. Castelli WP (1988) Cardiovascular disease in women. Am J Obstet Gynecol 158: 1553–1560

    PubMed  CAS  Google Scholar 

  5. Dyken ML, Wolf PA, Barnett HJM et al. (1984) Risk factors in stroke: a statement for physicians by the subcommittee on risk factors and stroke of the Stroke Council. Stroke 15: 1105–1111

    Article  Google Scholar 

  6. Gordon T, Kannel WB, Hjortland MC et al. (1978) Menopause and coronary heart disease: the Framingham study. Ann Intern Med 89: 157–161

    PubMed  CAS  Google Scholar 

  7. Bonithon-Kopp C, Scarabin P-Y, Darne B et al. (1990) Menopause-related changes in lipoproteins and some other cardiovascular risk factors. Int J Epidemiol 19: 42–48

    Article  PubMed  CAS  Google Scholar 

  8. Stampfer MJ, Colditz GA, Willett WC et al. (1991) Postmenopausal estrogen therapy and cardiovascular disease. Ten-year follow-up from the nurses’ health study. N Engl J Med 325: 756–762

    Article  PubMed  CAS  Google Scholar 

  9. Parrish HM, Carr LA, Hall DG et al. (1967) Time interval from castration in pre-menopausal women to development of excessive coronary atherosclerosis. Am J Obstet Gynecol 99: 155–162

    PubMed  CAS  Google Scholar 

  10. Barrett-Connor E, Bush T (1991) Estrogen and coronary heart disease in women. JAMA 265: 1861–1867

    Article  PubMed  CAS  Google Scholar 

  11. Godsland IF, Wynn V, Crook D et al. (1987) Sex, gonadal steroids and plasma lipoproteins: prevailing assumptions and unanswered questions. Am Heart J 114: 1467

    Article  PubMed  CAS  Google Scholar 

  12. Berrett-Connor E (1992) Risks and benefits of replacement estrogen. Annu Rev Med 43: 239–251

    Article  Google Scholar 

  13. Hong MK, Romm PA, Reagan K et al. (1992) Effects of estrogen replacement therapy on serum lipid values and angiographically defined coronary artery disease in postmenopausal women. Am J Cardiol 69: 176–178

    Article  PubMed  CAS  Google Scholar 

  14. Stampfer MJ, Colditz GA (1991) Estrogen replacement therapy and coronary heart disease: A quantitative assessment of the epidemiologic evidence. Prev Med 20: 47–63

    Article  PubMed  CAS  Google Scholar 

  15. Falkeborn M, Persson I, Terent A et al. (1993) Hormone replacement therapy and risk of stroke. Arch Intern Med 153: 1201–1209

    Article  PubMed  CAS  Google Scholar 

  16. Nabulsi AA, Folsom AR, White A et al (1993) Association of hormone- replacement therapy with various cardivascular risk factors in postmenopausal women. N Engl J Med 328: 1067–1075

    Article  Google Scholar 

  17. Meade TW (1988) Risks and mechanisms of cardiovascular events in users of oral contraceptives. Am J Obstet Gynecol 158: 1646–1652

    PubMed  CAS  Google Scholar 

  18. Stadel BV (1981) Oral contraceptives and cardiovascular disease. N Engl J Med 305: 612–618, 672–677

    Article  PubMed  CAS  Google Scholar 

  19. Knopp RH (1988) Cardiovascular effects of endogenous and exogenous sex hor-mones over a woman’s lifetime. Am J Obstet Gynecol 158: 1630–1643

    PubMed  CAS  Google Scholar 

  20. Corrao JM, Becker RC, Ockene IS et al. (1990) Coronary heart disease risk fac¬tors in women. Cardiology 77 [Suppl 2]: 8–24

    Article  PubMed  Google Scholar 

  21. Bush TL, Criqui MN, Cowan LD et al. (1987) Cardiovascular disease mortal¬ity in women: results from the Lipid Research Clinics Follow-up Study. In: Eaker ED, Packard B, Wenger NK et al. (eds) Coronary heart disease in women. Proceedings of an NIH workshop. Haymarket Doyma, New York, pp 106–111

    Google Scholar 

  22. Paganini-Hill A, Ross RK, Henderson BE (1988) Postmenopausal oestrogen treatment and stroke: a prospective study. BMJ 297: 519–522

    Article  PubMed  CAS  Google Scholar 

  23. Weisfelt ML (1985) The aging heart. Hosp Pract 20: 115–119

    Google Scholar 

  24. Tepper R, Goldberger S, May JY et al. (1992) Hormonal replacement therapy in postmenopausal women and cardiovascular disease: an overview. Obstet Gynecol Surv 47: 426–431

    Article  PubMed  CAS  Google Scholar 

  25. Rowland M, Roberts J (1982) Blood pressure levels of persons 6–74 years: United States 1976–1980. National health and Nutrition Examination Survey II. NCHS advance data. Vital and Health Statistics of the National Center for Health Statistics, no 84. US Department of Health and Human Services Washington

    Google Scholar 

  26. Lerner DJ, Kannel WB (1986) Patterns of coronary heart disease morbidity and mortality in the sexes: a 26–year follow-up of the Framingham population. Am Heart J 111: 383–390

    Article  PubMed  CAS  Google Scholar 

  27. Hall PM (1990) Hypertension in women. Cardiology 77 [Suppl 2]: 25–30

    Article  PubMed  Google Scholar 

  28. Kannel WB, Doyle JT, Ostfeld AM et al. (1984) Optimal resources for primary prevention of atherosclerotic diseases. Circulation 70: 157A–205A

    Article  Google Scholar 

  29. Staessen J, Bulpitt CJ, Fagard R et al. (1989) The influence of menopause on blood pressure. J Hum Hypertens 3: 427–433

    PubMed  CAS  Google Scholar 

  30. Posner BM, Cupples LA, Miller DR et al. (1993) Diet, menopause, and serum cholesterol levels in women: the Framingham study. Am Heart J 125: 483–489

    Article  PubMed  CAS  Google Scholar 

  31. Hjortland MC, McNamara PM, Kannel WB (1976) Some atherogenetic concommitants of menopause: the Framingham Study. Am J Epidemiol 103: 304–311

    PubMed  CAS  Google Scholar 

  32. Hughes GS, Mathur RS, Margolius HS (1989) Sex steroid hormones are altered in essential hypertension. J Hypertens 7: 181–187

    Article  PubMed  CAS  Google Scholar 

  33. Messerli FH, Garavaglia GE, Schmieder RE et al (1987) Disparate cardiovascu¬lar findings in men and women with essential hypertension. Ann Intern Med 107: 158–161

    PubMed  CAS  Google Scholar 

  34. Razay G, Heaton KW, Bolton CH (1992) Coronary heart disease risk factors in relation to the menopause. Q J Med 85: 889–896

    PubMed  CAS  Google Scholar 

  35. Bush TL, Miller VT (1987) Effects of pharmacologic agents used during menopause: impact on lipids and lipoproteins. In: Mishefi. DR (ed) Menopause: physiology and pharmacology. Year Book Medical Publishers, Chicago, pp 187–208

    Google Scholar 

  36. Crook D, Godsland IF, Wynn V (1988) Oral contraceptives and coronary heart disease: modulation of glucose tolerance and plasma lipid risk factors by progestins. Am J Obstet Gynecol 158: 1612–1620

    PubMed  CAS  Google Scholar 

  37. Castelli WP, Garrison RJ, Wilson PWF et al. (1986) Incidence of coronary heart disease and lipoprotein cholesterol levels: the Framingham Study. JAMA 256: 2835–2838

    Article  PubMed  CAS  Google Scholar 

  38. Jensen J (1991) Effects of sex steroids on serum lipids and lipoproteins. Baillieres Clin Obstet Gynaecol 5: 867–887

    Article  PubMed  CAS  Google Scholar 

  39. Jenner JL, Ordovas JM, Lamon-Fava S et al. (1993) Effects of age, sex, and menopausal status on plasma lipoprotein(a) levels. Circulation 87: 1135–1141

    PubMed  CAS  Google Scholar 

  40. Moorjani S, Dupont A, Labrie F et al. (1991) Changes in plasma lipoprotein and apolipoprotein composition in relation to oral versus percutaneus administration of estrogen alone or in cyclic association with Ultrogestan in menopausal women. J Clin Endocrinol Metabol 73: 373–377

    Article  CAS  Google Scholar 

  41. Hubert HB, Feinleib M, McNamara PM et al. (1983) Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Study. Circulation 67: 968–976

    Article  PubMed  CAS  Google Scholar 

  42. Lapidus L, Bengtsson C, Larsson B et al. (1984) Distribution of adipose tissue and risk of CVD and death: a 12-year follow-up of participants in the study of women in Goteborg, Sweden. BMJ 289: 1257–1261

    Article  PubMed  CAS  Google Scholar 

  43. Kafrissen ME (1990) Prevention of cardiovascular risk in women. A new concern for the obstetrician/gynecologist. Acta Obstet Gynecol Scand Suppl 152: 13–20

    Article  PubMed  CAS  Google Scholar 

  44. Haffner SM, Katz MS, Dunn JF (1991) Increased upper body and overall adiposity is associated with decreased sex hormone binding globulin in postmenopausal women. Int J Obes 15: 471–478

    PubMed  CAS  Google Scholar 

  45. Khaw KT, Tazuke S, Barrett-Connor E (1988) Cigarette smoking and levels of adrenal androgens in postmenopausal women. N Engl J Med 318: 1705–1708

    Article  PubMed  CAS  Google Scholar 

  46. Meade TW, Mellows S, Brozovic M et al. (1986) Haemostatic function and ischemic heart disease: principal results of the Northwick Park Heart Study. Lancet 2: 533–537

    Article  PubMed  CAS  Google Scholar 

  47. Scarabin PV, Bonithon-Kopp C, Bara L et al. (1990) Factor VI activation and menopausal status. Thromb Res 57: 227–234

    Article  PubMed  CAS  Google Scholar 

  48. Meade TW, Brozovic M, Chakrabarti R et al. (1976) An epidemiological study of the haemostatic and other effects of oral contraceptives. Br J Haematol 34: 353–364

    Article  PubMed  CAS  Google Scholar 

  49. Kaplan JR, Manuck SB, Clarkson TB et al. (1982) Social status, environment, and atherosclerosis in cynomolgus monkeys. Atherosclerosis 2: 359–368

    CAS  Google Scholar 

  50. Schneiderman N (1987) Psychophysiologic factors in atherogenesis and coronary artery disease. Circulation 76 [Suppl I]: 1–47

    Article  Google Scholar 

  51. Haynes SG, Feinleib M, Kannel WB (1980) The relationship of psychosocial fac-tors to CHD in the Framingham Study. Am J Epidemiol 111: 37–58

    PubMed  CAS  Google Scholar 

  52. Jacobsen BK, Thelle DS (1988) Risk factors for coronary heart disease and level of education. Am J Epidemiol 127: 923–932

    PubMed  CAS  Google Scholar 

  53. Clarkson TB, Adams MR, Kaplan JR et al. (1989) From menarche to meno¬pause: coronary artery atherosclerosis and protection in cynomolgus monkeys. Am J Obstet Gynecol 160: 1280–1285

    PubMed  CAS  Google Scholar 

  54. Adams MR, Kaplan JR, Clarkson TB et al. (1985) Ovariectomy, social status, and atherosclerosis in cynomolgus monkeys. Atherosclerosis 5: 192–200

    CAS  Google Scholar 

  55. Adams MR, Kaplan JR, Manuck SB et al. (1990) Inhibition of coronary athe-rosclerosis by 17-beta estradiol in ovariectomizes monkeys. Atherosclerosis 10: 1051–1057

    CAS  Google Scholar 

  56. Janowsky DS, Davis JM (1970) Progesterone-estrogen effects on uptake and release of norepinephrine by synaptosomes. Life Sci 9: 525–531

    Article  PubMed  CAS  Google Scholar 

  57. Klaiber EL, Kobayashi Y, Broverman DM et al. (1971) Plasma monoamine oxi-dase activity in regularly menstruating women and in amenorrheic women receiving cyclic treatment with estrogens and a progestin. J Clin Endocr 33: 630–638

    Article  PubMed  CAS  Google Scholar 

  58. Ford SP, Reynolds LP (1983) Role of adrenergic receptors in mediating estradiol-17 p-stimulated increases in uterine blood flow of cows. J Anim Sci 57: 665–672

    PubMed  CAS  Google Scholar 

  59. Rosen SG, Berk MA, Popp DA et al. (1984) (32- and a2-adrenergic receptors and receptor coupling to adenylate cyclase in human mononuclear leukocytes and platelets in relation to physiological variations of sex steroids. J Clin Endocrinol Metab 58: 1068–1076

    Article  PubMed  CAS  Google Scholar 

  60. Zhang A, Altura BT, Altura BM (1992) Endothelial-dependent sexual dimorph¬ism in vascular smooth muscle: role of Mg2+ and Na+. Br J Pharmacol 105: 305–310

    PubMed  CAS  Google Scholar 

  61. McGill HC (1989) Sex steroid hormone receptors in the cardiovascular system. Postgrad Med 64–68

    Google Scholar 

  62. Stumpf W, Sar M (1977) The heart: a target organ for estradiol. Science 196: 319–321

    Article  PubMed  CAS  Google Scholar 

  63. Colburn P, Buonassisi V (1978) Estrogen-binding sites in endothelial cell culture. Science 201: 817–819

    Article  PubMed  CAS  Google Scholar 

  64. Magness RR, Rosenfeld CR (1989) Local and systemic estradiol-17 (3: effects on uterine and systemic vasodilation. Am J Physiol 257 (Endocrinol Metab 19): E526–E542

    Google Scholar 

  65. Woods JW (1988) Oral contraceptives and hypertension. Hypertension 11[Suppl II]: II–11–II–15

    Google Scholar 

  66. Jespersen CM, Arming K, Hagen C et al. (1983) Effects of natural oestrogen the rapy on blood pressure and renin-angiotensin system in normotensive and hypertensive menopausal women. J Hypertens 1: 361–364

    Article  PubMed  CAS  Google Scholar 

  67. Lippman ME, Bates S, Huff KK et al. (1987) Estrogens regulate production of specific growth factors in hormone-dependent human breast cancer. J Lab Clin Med 109: 230–235

    PubMed  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1994 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Manhem, K. (1994). Cardiovascular Risk in Postmenopausal Women: What is Known and what is Unknown. In: Safar, M.E., Stimpel, M., Zanchetti, A. (eds) Hypertension in Postmenopausal Women. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-79077-5_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-79077-5_2

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-58144-4

  • Online ISBN: 978-3-642-79077-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics