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William B. Kannel, MD, MPH; Peter W. F. Wilson, MD

Arch Intern Med. 1995;155(1):57-61.

Abstract
Objective
To compare the coronary disease experience of men and women in a community setting.

Design and Setting
Prospective cohort study.

Patients
Long-term follow-up of a population-based sample of 5209 men and women.

Results
Women outlive men and experience fewer cardiovascular events. By middle age, women lag 20 years behind men in the incidence of myocardial infarction, but the gap closes in the elderly, when cardiovascular disease becomes the leading cause of death in women as well as in men. Menopause promptly escalates coronary disease risk threefold and greatly erodes the advantage over men. Women and men share the same major risk factors for coronary disease, although women experience a lower absolute risk. However, high ratios of total/high-density lipoprotein cholesterol level ratios, left ventricular hypertrophy, and diabetes tend to eliminate the female advantage.

Conclusion
Coronary disease is not a minor problem in women. Consequently, women should take vigorous preventive measures. There is a need for particular attention to glucose tolerance and blood lipid levels and a greater sense of urgency when hypertension progresses to left ventricular hypertrophy.

(Arch Intern Med. 1995;155:57-61)

Author Affiliations
From the Department of Medicine, Section of Preventive Medicine and Epidemiology, Evans Memorial Research Foundation, Boston (Mass) University School of Medicine; and the Framingham Study, Framingham, Mass.

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