EPIDEMIOLOGY OF CARDIOVASCULAR RISK FACTORS IN WOMEN

招募的女性心血管疾病的健康女性研究

The Healthy Women Study of cardiovascular disease among women recruited 541 premenopausal women between the ages of 42-50 from 1983-84. The goal of the study has been to describe the changes in risk factors for cardiovascular disease during the pre-, peri- and postmenopause, the relationship of risk factor changes to life-style, behavioral and psychological attributes, sex-steroid hormones and insulin, and the use and effect of hormone replacement therapy on risk factors. Most of the women are now postmenopausal, and in their middle 50's. Approximately 40% are using hormone replacement therapy. The response rate at 5th postmenopausal exam is approximately 80%. We have documented the substantial increase in LDLc, blood insulin, decreased HDL2c, and clotting factor changes during the peri- to postmenopause. There is an approximate one pound per year gain in weight, i.e. 10-12 pounds over 10 years, and increased waist-to-hip ratio related to weight gain. The blood estrone levels increase with weight postmenopausally. Decreased exercise was linked to weight gain. Women who became menopausal were not more depressed, anxious or distressed than their age-matched premenopausal controls or postmenopausal women taking hormones. The only subgroup vulnerable to depression during the menopausal transition were women who elected to use hormones and had low self esteem at baseline evaluation. We have documented a high prevalence of carotid artery plaque (57%) and a strong relationship between plaque and baseline (premenopause) LDLc, HDLc, insulin and other risk factors, and blood pressure to wall thickness. We propose to continue follow-up to determine characteristics of changes in risk factors, behavioral/psychological attributes and to determine the relationship between risk factors, and their changes and atherosclerosis, plaque and wall thickness. We will determine the interrelationship of lifestyle and behavioral attributed to sex-steroid hormones and insulin and the level of hormones to atherosclerosis. We will determine the association of lifestyle to amount and distribution of body fat measured by DEXA and CT of the abdomen.