Re: Cardiovascular event risk in relation to dietary fat intake in middle-aged individuals: data from The Malmo Diet and Cancer Study.

This study illustrates some of what I was saying about endogenous
hormones and heart disease.

Severity of cardiovascular disease in women: Relation with exposure to
endogenous estrogen

Katerina Saltikia, Charalambos Doukasa, John Kanakakisa, Eleni
Anastasioua, Emily Mantzoua and Maria Alevizaki, a, ,
aEndocrine Unit, Evgenidion Hospital and Dept Medical Therapeutics,
ALEXANDRA Hospital, Athens University School of Medicine, Athens,
Greece

Abstract
Objectives
Coronary artery disease (CAD) is more common in men than in women.
Endogenous sex steroids may be the main factor responsible, as long-
term estrogen action appears to be protective. The aim of the study
was to investigate the predisposing factors responsible for the
severity of CAD in women.

Methods
One hundred and eight women (100 menopausal) undergoing coronary
angiography were studied. Reproductive function was recorded. The
severity of CAD was assessed by the number of arteries with severe
stenosis, the presence of angina and myocardial infarctions (MI).

Results
The time since menopause (TSM) was significantly longer in women with
angina and with MIs compared to those without (20.3 ± 8.7 years versus
15.8 ± 8.7 years and 22.6 ± 8.6 years versus 18.1 ± 8.9 years, p <
0.05), independently of chronological age. The age at menopause was
significantly younger in women who had 2 MIs compared to those with 1
or 0 MI (41.5 ± 3.5, 47.5 ± 5.3 and 48.4 ± 5.4 years, respectively; p
= 0.04); the total duration of menstrual cyclicity was inversely
related to the number of MIs (35.6 ± 5.8, 34.2 ± 5.3 and 28.3 ± 3.3
years, 0, 1 and 2 MIs, respectively; p = 0.03).

Conclusions
The severity of CAD in women referred for coronary angiography is
correlated with measures of exposure to endogenous estrogen. Both the
TSM and the age at menopause are aggravating factors for MI,
independently of age. There is an independent protective effect of the
duration of estrogen exposure on the number of MIs; this has not been
reported before and supports the protective role of the length of
exposure to endogenous estrogen, especially for the occurrence of MI
in this selected group of women.

Corresponding author. Tel.: +30 2103381393; fax: +30 2107704143.

Maturitas
Volume 55, Issue 1, 20 August 2006, Pages 51-57

* * *
I have not read the whole article, but I assume the way they calculate
total duration of menstrual cyclicity is to take age at menopause,
subtract age at menarche, and subtract time while pregnant, or
something along those lines.

One of the first things they ask you when you are diagnosed with
breast cancer is your age at menarche, age at menopause (if
applicable), number of pregnancies and number of births. They even
ask whether you breastfed your kids and if you had a miscarriage they
want to know what trimester it occurred in. It's the same concept,
but longer duration of menstrual cyclicity *increases* breast cancer
risk.

I should note that androgens also decrease at menopause and there is
some evidence that androgens lower risk of CVD in women. This is
controversial, however. Women with higher BMI tend to have higher
androgen levels. If you don't correct for BMI you will come up with
an association between higher androgens and higher CVD risk. If you
correct for BMI, that association tends to disappear or go the other
way.

Marilyn

.

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