Gender differences in cardiovascular disease : an epidemiologic study of endocrine factors

The initial interst in coronary- heart disease research in the 1950s centered primarily on men because of its emergence as a major cause of morbidity and mortality in men around middle age. In women, the incidence of coronary heart disease is low at younger age and increases after middle age, though the occurrence remains lower in women than in men at all ages. The fact that cardiovascular disease is the major cause of morbidity and mortality in women has been recognized already for many years and the last decade much effort has been put in describing and studying cardiovascular disease in women. Despite the research that has been carried out on the differences in cardiovascular disease between the sexes, the gender gap in coronary- heart disease occurrence is not completely understood until now. 1 The work presented in this thesis aims at gaining insight into gender specific issues of cardiovascular disease and the cause of the rising incidence of cardiovascular disease in women after middle age by studying putative endocrine and metabolic risk factors. Data from various population-based studies were used to study these issues. In chapter 2, studies on classical cardiovascular disease risk factors attenuating the female advantage with regard to cardiovascular disease occurrence are presented. Chapter 3 contains studies on sex specific determinants of cardiovascular disease with a focus on sex steroids. In chapter 4, studies on alternative endocrine cardiovascular disease risk factors in postmenopausal women are described. In chapter 5, the results described in this thesis are placed in a broader context, some methodological considerations are discussed, and views on further research regarding gender specific issues of cardiovascular disease are put forward.

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