Cardiovascular disease in women : an epidemiological study of atherogenic factors

Cardiovascular disease is generally considered to be a disorder of men. One reason for this is the low incidence of the disease in women at younger age. At older age. however. cardiovascular disease also becomes the most important cause of mortality in women: at age 40. 15% of the mortality in women is due to this disease compared to 45% at age 70.1 Currently. there is an increased recognition of the public health importance of cardiovascular disease in women. but data on cardiovascular risk factors are limited. The investigation of the determinants of cardiovascular disease in women was the main purpose of the work underlying the studies presented in this thesis. Traditionally. epidemiologists have studied cardiovascular disease by examination of the relation between potential risk factors and the prevalence or incidence of cardiovascular events. One of the disadvantages of these studies is that events reflect a near end-stage of disease which limits the study of risk factors at earlier stages of disease. The majorunderlyingprocess of cardiovascular disease is atherosclerosis. To study atherosclerosis non-invasively in asymptomatic non-hospitalized subjects it is necessary to rely on vessels other than the coronary or cerebral. In the studies presented in this thesis the presence of radiographically detectable calcified plaques in the aorta was used as a measure of atherosclerosis. Its ability to reflect a generalized process was studied by examination of the association of aortic atherosclerosis with cardiovascular morbidity and mortality using follow-up data of 1.359 men and 1,597 women of the EPOZ study (Epidemiological Preventive Organization Zoeterrneer). and of 2,336 men and 2,873 women of the Framingham Study.

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