Perlman J A, Wolf P H, Ray R, Lieberknecht G
Contraceptive Evaluation Branch, National Institute of Child Health and Human Development, Bethesda, MD 20892.
Am J Obstet Gynecol. 1988 Jun;158(6 Pt 2):1568-74. doi: 10.1016/0002-9378(88)90192-5.
Large prospective studies and intervention trials have identified major risk factors for premature heart disease in men, while the Framingham Heart Disease Study has provided the leading evidence of predictors of cardiovascular disease in women. We evaluated the role of these risk factors in a 13-year follow-up study of 8935 premenopausal and 2716 postmenopausal women in the Walnut Creek Contraceptive Drug Study cohort in Northern California. Elevated cholesterol levels, high blood pressure, smoking, obesity, family history of heart disease, and diabetes were investigated for their contribution to premature death due to all causes and due to cardiovascular disease. In addition, risk factor profiles were developed separately for users and nonusers of Premarin (conjugated estrogen) in the postmenopausal cohort. The results show that the strongest predictors of cardiovascular mortality among premenopausal women were smoking, high blood pressure, and diabetes, with relative risks of 2.8, 10.5, and 11.6, respectively. A disparity between high cardiovascular risk factor prevalence and low rates of premature heart disease indicates that the high relative risks will not be accompanied by large attributable risks. Nevertheless, the study reconfirms the need for screening women for heart disease risk because life-style changes can improve cardiovascular risk factors and can potentially reduce the chance of premature death even further.
大型前瞻性研究和干预试验已确定了男性过早患心脏病的主要风险因素，而弗明汉姆心脏病研究则提供了女性心血管疾病预测因素的主要证据。我们在加利福尼亚州北部核桃溪避孕药研究队列中，对8935名绝经前女性和2716名绝经后女性进行了为期13年的随访研究，评估了这些风险因素的作用。研究调查了胆固醇水平升高、高血压、吸烟、肥胖、心脏病家族史和糖尿病对各种原因及心血管疾病导致的过早死亡的影响。此外，还为绝经后队列中使用倍美力（共轭雌激素）和未使用倍美力的女性分别制定了风险因素概况。结果显示，绝经前女性心血管死亡率的最强预测因素是吸烟、高血压和糖尿病，相对风险分别为2.8、10.5和11.6。心血管疾病高风险因素患病率与过早心脏病低发病率之间的差异表明，高相对风险不会伴随着高归因风险。尽管如此，该研究再次证实了对女性进行心脏病风险筛查的必要性，因为生活方式的改变可以改善心血管疾病风险因素，并有可能进一步降低过早死亡的几率。
