Coronary Heart Disease In Women Research Articles

ASSOCIATION OF BRACHIAL ARTERY SIZE WITH CARDIOVASCULAR RISK FACTORS

Non-invasive assessment of brachial artery vasoreactivity is used as a surrogate marker for coronary heart disease (CHD). Recent data suggests baseline brachial artery size is an independent predictor of CHD in women. PURPOSE To examine the influence of CHD risk factors on brachial artery size in men and women (n = 301, Age: 55 ± 5y). METHODS Following a fast and supine rest, brachial artery diameters were imaged before and after 5min of forearm occlusion. Still images of the artery in diastole were analyzed. CHD risk scores were calculated from hematologic and hemodynamic measures and the Framingham prediction algorithm. RESULTS Average lipid profiles (HDL: Women: 64 ± 13; Men: 48 ± 9mg/dl, p = 0.001; LDL: Women: 132 ± 25; Men: 137 ± 23mg/dl, p = 0.07), diastolic pressure (Women: 76 ± 7; Men: 78 ± 8mmHg, p = 0.02) and glucose (Women: 97 ± 9; Men: 101 ± 9mg/dl, p = 0.02) were more favorable in women. Brachial artery size was associated with LDL (r = 0.18, p = 0.003), glucose (r = 0.27, p = 0.001), diastolic pressure (r = 0.21, p = 0.001) and HDL (Women: r = −0.24, p = 0.01; Men: r = −0.24, p = 0.05). The 10y predicted CHD risk score indicates both women (6.08 ± 3.42) and men (10.29 ± 5.99) were at average risk for CHD. Moreover, the risk score was related to brachial artery size (r = 0.33, p = 0.001). Finally, baseline vessel size was inversely related to vasoreactivity following occlusion (r = −0.263, p = 0.001). After adjusting for vessel size, vasoreactivity was significantly lower in women (Women: 4.67%, CI: 4.10 to 5.25; Men: 6.73%, CI: 5.85 to 7.61, p = 0.001). CONCLUSION Independent CHD risk factors and profiles are associated with brachial artery size in men and women. Vessel size is inversely related to vasoreactivity. After correcting for vessel size women have lower reactivity than men. The association between CHD risk factors and vessel size warrants careful consideration in interpretation of vasoreactivity and should be included as an independent outcome measure in trials. Supported in part by a Grant from the National Dairy Council

A prospective study of sleep duration and coronary heart disease in women.

Long-term sleep deprivation is common in today's society. Recent experiments have demonstrated that short-term sleep deprivation in healthy subjects results in adverse physiologic changes, including a decreased glucose tolerance and an increased blood pressure. However, the long-term health consequences of long-term sleep deprivation are unclear. The objective of this study was to determine whether decreased sleep duration (from self-reports) is associated with an increased risk of coronary events. We studied a cohort of 71 617 US female health professionals (aged 45-65 years), without reported coronary heart disease (CHD) at baseline, who were enrolled in the Nurses' Health Study. Subjects were mailed a questionnaire in 1986 asking about daily sleep duration. Subjects were followed up until June 30, 1996, for the occurrence of CHD-related events. We assessed the relationship between self-reported sleep duration and incident CHD. A total of 934 coronary events were documented (271 fatal and 663 nonfatal) during the 10 years of follow up. Age-adjusted relative risks (95% confidence intervals) of CHD (with 8 hours of daily sleep being considered the reference group) for individuals reporting 5 or fewer, 6, and 7 hours of sleep were 1.82 (1.34-2.41), 1.30 (1.08-1.57), and 1.06 (0.89-1.26), respectively. The relative risk (95% confidence interval) for 9 or more hours of sleep was 1.57 (1.18-2.11). After adjusting for various potential confounders, including snoring, body mass index, and smoking, the relative risks of CHD (95% confidence intervals) for individuals reporting 5 or fewer, 6, and 7 hours of sleep were 1.45 (1.10-1.92), 1.18 (0.98-1.42), and 1.09 (0.91-1.30), respectively. The relative risk (95% confidence interval) for 9 or more hours of sleep was 1.38 (1.03-1.86). Short and long self-reported sleep durations are independently associated with a modestly increased risk of coronary events.

Presenting Symptoms and Diagnosis of Coronary Heart Disease in Women

Coronary artery disease generally presents later in women than men and more frequently with atypical symptoms. From the Framingham data, angina is the commonest initial clinical presenting symptom of coronary artery disease in women, compared with myocardial infarction for men. Obtaining a careful history is essential in evaluating a woman for possible coronary artery disease. Research is beginning to elucidate some barriers to the diagnosis of coronary artery disease in women.

Retinal arteriolar narrowing is associated with coronary heart disease in women, but not men

Retinal arteriolar narrowing is associated with coronary heart disease in women, but not men

Presenting symptoms and diagnosis of coronary heart disease in women.

Coronary artery disease generally presents later in women than men and more frequently with atypical symptoms. From the Framingham data, angina is the commonest initial clinical presenting symptom of coronary artery disease in women, compared with myocardial infarction for men. Obtaining a careful history is essential in evaluating a woman for possible coronary artery disease. Research is beginning to elucidate some barriers to the diagnosis of coronary artery disease in women.

Invited commentary

Invited commentary

Hormone Replacement Therapy and Coronary Heart Disease in Women: A Review of the Evidence

It is well documented that coronary heart disease (CHD) is the leading cause of death in women-especially postmenopausal women. The role of hormone replacement therapy (HRT) in prevention of CHD has been considered for many years. Early epidemiological studies suggested estrogen to have a potential cardioprotective role, noting that premenopausal women have a decreased risk of developing CHD compared with men. Later observational studies showed decrease of CHD risk in postmenopausal women on HRT. By 1996, estrogen (specifically Premarin) was one of the most dispensed medications in the United States. Major medical organizations such as the American College of Physicians and American College of Obstetricians and Gynecologists widely endorsed and encouraged HRT for CHD risk reduction, along with using HRT for other potential benefits (such as osteoporosis prevention). Unfortunately, recent clinical trials seem to raise more questions than provide definitive proof in the protective role of estrogen in CHD. A review of recent and ongoing observational studies and clinical trials may help guide physicians in their recommendation and discussion of the role of HRT in postmenopausal women. As this article was being prepared for publication, reports from both the Heart and Estrogen/Progestin Replacement Study Follow-up (HERS II) and the Women's Health Initiative (WHI) were published. Both studies concluded that HRT has no role in primary or secondary prevention of CHD in women.

Usefulness of lipid-lowering therapy in elderly patients

O of all acute myocardial infarcts and 60% of all acute myocardial infarction deaths occur in individuals aged 75 years. Forty-five percent of octogenarians have clinical evidence of cardiovascular disease. Coronary heart disease (CHD) is the most common problem; 58% of mortalities at 85 years of age are due to cardiovascular disease. Concomitantly, men and women aged 60 years have the highest prevalence of hypercholesterolemia. Based on Framingham Study data, although total cholesterol level loses its predictive value for CHD in men after age 70, it predicts CHD in women into the ninth decade. The total: high-density lipoprotein cholesterol ratio predicts CHD even at ages 80 years.2 Survey data demonstrate marked undertreatment of hypercholesterolemia in elderly subjects. Some of this reflects less aggressive screening in elderly populations, some is caused by the lower priority given to dyslipidemia by physicians and patients, some involves concerns about drug safety, and some is predicated by concerns about drug costs. Time trends in cholesterol-lowering therapy among 5,000 community-dwelling individuals aged 65 years in the Cardiovascular Health Study identified that 4.5% of eligible men and 5.9% of eligible women were treated with lipid-lowering agents in 1989 to 1990, increasing only to 8.1% of men and 10.0% of women in 1995 to 1996.3 In contrast, clinical trials of statin therapy show that the effectiveness of lipid lowering is similar in elderly and nonelderly populations, and that the incidence of adverse drug events and laboratory abnormalities is also similarly low in the elderly and nonelderly. Importantly, the statin-related decrease in low-density lipoprotein cholesterol levels in primary and secondary coronary prevention trials decreased the risk of CHD and of all-cause mortality. The risk reduction, about 30%, was similar in middle-aged and elderly patients treated for about 5 years (with data available to age 75 years). In patients of the Scandinavian Simvastatin Survival Study (4S), simvastatin-treated patients had a 34% decrease in all-cause mortality, due predominantly to a 43% decrease in CHD mortality. Although there was similar decrease in the relative risk for major CHD events in those older and younger than age 65, the absolute reduction was twice as great in older patients because mortality rates increase substantially with older age. Patients with myocardial infarction aged 65 to 75 years in the Cholesterol And Recurrent Events (CARE) trial showed a 32% decrease in major coronary events in the pravastatintreated group, including a 45% decrease in coronary death and a 40% decrease in stroke. Treatment of 1,000 older patients prevented 225 cardiovascular hospitalizations, in contrast to 121 hospitalizations prevented in 1,000 younger patients. Patients 65 years in the Long-term Intervention with Pravastatin and Ischemic Disease (LIPID) study, all of whom had average or below average cholesterol levels after myocardial infarction or unstable angina, had a 25% risk reduction in major coronary events when receiving pravastatin 40 mg/day, identical to the benefit of patients 65 years old.6 In the Primary Prevention AirForce/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS), there was a 32% decrease in first acute coronary event beyond age 65, compared with a 38% decrease at age 65 years. Patients 65 years of age were not included in the West Of Scotland COronary Prevention Study (WOSCOPS) primary prevention trial.8 Fewer than 20% of patients eligible for therapy based on National Cholesterol Education Program II guidelines in the Cardiovascular Health Study were untreated at baseline initiated therapy in the 6 years of follow-up, even those with a history of CHD.3 In the recently presented British Heart Protection Study (HPS), which enrolled patients 80 years of age, there was comparable benefit in the population below age 65, age 65 to 69, 70 to 74, and 75 years of age. In elderly, as in younger patients, simvastatin 40 mg/day reduced the risk of myocardial infarction, stroke, and myocardial revascularization by 1/3. There was no excess of adverse events, including abnormal blood enzyme levels, in older compared with younger patients. Current information is limited regarding patients 75 years of age. Given the comparable pathobiology of atherosclerosis at middle and elderly ages, the high attributable risk of hypercholesterolemia and high prevalence of established CHD at elderly ages, and the substantial and comparable CHD risk reduction associated with lipid-lowering at middle and elderly ages, a more aggressive screening of older individuals for lipid abnormalities is recommended, along with the institution of lipid-lowering therapy based on National Cholesterol Education Program III guidelines. From the Department of Cardiology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia. Manuscript received May 14, 2002; revised manuscript received and accepted June 4, 2002. Address for reprints: Nanette K. Wenger, MD, Emory University School of Medicine, 69 Jesse Hill Jr. Drive, SE, Atlanta, Georgia 30303. E-mail: nwenger@emory.edu.

Migraine and coronary heart disease in women and men.

We evaluated migraine as an independent risk factor for subsequent coronary heart disease (CHD) events among women in the Women's Health Study (WHS) and men in the Physicians' Health Study (PHS). Although several studies have suggested that migraine is associated with increased risk of stroke, there are few and conflicting data on whether migraine predicts risk of future CHD events. The WHS is an ongoing randomized, double-blind, placebo-controlled trial of low-dose aspirin and vitamin E in the primary prevention of cardiovascular disease and cancer in 39876 women health professionals aged > or =45 years in 1993, and the PHS is a completed randomized, double-blind, placebo-controlled trial of aspirin and beta-carotene in the primary prevention of cardiovascular disease and cancer in 22071 men physicians aged 40 to 84 years in 1982. Primary endpoints were defined as major CHD (nonfatal myocardial infarction [MI] or fatal CHD) and total CHD (major CHD plus angina and coronary revascularization). After adjusting for other CHD risk factors, female health professionals and male physicians reporting migraine were not at increased risk for subsequent major CHD (women: relative risk [RR], 0.83; 95% confidence interval [CI], 0.53 to 1.29; men: RR, 1.02; 95% Cl, 0.79 to 1.31) or total CHD (women: RR, 1.01; 95% Cl, 0.76 to 1.34; men: RR, 0.98; 95% Cl, 0.82 to 1.18). When considered separately, there was also no increase in risk of MI or angina. These prospective data suggest that migraine is not associated with increased risk of subsequent CHD events in women or men.

Public health addresses racial and ethnic disparities in coronary heart disease in women: perspectives from the Centers for Disease Control and Prevention

Heart disease is the leading cause of death and an important contributor to long-term disability in women in the United States.1–3 Coronary heart disease (CHD), the principal form of heart disease in the United States, is also the single largest killer in American women.3 Although the dramatic declines noted in the last five decades,4,5 constitute one of the greatest public health achievements of the twentieth century,6 marked racial and ethnic disparities have persisted in the magnitude of the rate of decline itself as well as in the prevalence of CHD risk factors, access to care, and quality of the care received.7–14 Data from the Centers for Disease Control and Prevention (CDC) suggest that the disparities in CHD mortalities have not narrowed.15 In this issue of Women’s Health Issues, Johnson and Fulp16 have provided an overview of these disparities and recommendations for needed interventions. In this accompanying commentary, we describe the public health response to these disparities and discuss specific activities and initiatives in research, policy, and practice at the CDC designed to help eliminate racial and ethnic disparities in CHD.

Racial and ethnic disparities in coronary heart disease in women: prevention, treatment, and needed interventions

In the year 2002, the study of cardiovascular disease (CVD) provides some of the most exciting opportunities for prevention and treatment. The emergence of gene therapy, new markers to better identify risk, new pharmaceuticals, and the potential to develop “individualized” therapy provide the foundation for more effective cures and targeted prevention. The role of CVD as a major cause of mortality and as a significant cause of morbidity in the female population has become clearer and better understood among medical and lay populations. 1 Robertson R.M. Women and cardiovascular disease the risks of misperception and the need for action. Circulation. 2001; 103: 2318-2320 Crossref PubMed Scopus (61) Google Scholar Yet, significant racial and ethnic disparities exist with regard to prevalence, mortality, and morbidity. This paper will discuss these disparities, the degree to which they can be explained, potential methods for decreasing them, and future recommendations.

17β-estradiol inhibits the adhesion of leukocytes in TNF-α stimulated human endothelial cells by blocking IL-8 and MCP-1 secretion, but not its transcription

Inflammation, and especially mononuclear cell adhesion to endothelium, is an important physiopathological component of atherosclerosis. Since coronary heart disease in women of reproductive age and/or with estrogen replacement therapy is reduced, our aim was to determine if 17β-estradiol had a regulatory effect on the adhesion of lymphocytes to the endothelium. We performed U-937 cells adhesion assays in TNF-α-stimulated HUVECs, and we also quantitated IL-8 and MCP-1 in culture supernatants, in the presence or not of 17β-estradiol. The presence of α- and β-estrogen receptors was determined by Western blot and RT-PCR, respectively, whereas the transcription of both chemokines was evaluated by RT-PCR. The results showed a 35% decrease in the adhesion of U-937 monocyte cells to TNF-α-stimulated HUVECs, and a 54% and 65% inhibition of TNF-α-induced IL-8 and MCP-1 secretion by physiological and physiologically high doses of 17β-estradiol. The hormone did not affect the transcription of both chemokine genes. Tamoxifen reverted the inhibitory effect induced by 17βestradiol. In conclusion, 17β-estradiol modifies the adhesion of leukocytes to endothelial cells by inhibiting the secretion, but not the gene transcription, of proinflammatory chemokines.

Relation of serum levels of sex hormone binding globulin to coronary heart disease in postmenopausal women

Hyperandrogenemia and low levels of sex hormone binding globulin (SHBG) are frequently found in women with metabolic syndrome, which is characterized by low high-density lipoprotein cholesterol, hypertriglyceridemia, obesity, and hyperinsulinemia. The specific contribution of these various factors to coronary heart disease (CHD) is controversial. The coronary angiograms of 87 consecutive postmenopausal women were evaluated using 2 semiquantitative scoring systems to estimate the extent of focal and diffuse vessel wall alterations. Fasting sera were analyzed for levels of glucose, lipids, insulin, leptin, dehydroepiandrosterone sulfate, testosterone, and SHBG. Obesity was assessed by measuring body mass index, waist-to-hip ratio, skinfold thicknesses, and body impedance. After adjusting for age, there were significant differences in 55 women with CHD compared with 32 women without CHD: higher levels of low-density lipoprotein cholesterol (159 ± 51 vs 132 ± 39 mg/dl), apolipoprotein B (121 ± 33 vs 102 ± 29 mg/dl), triglycerides (115 vs 91 mg/dl), and basal insulin (7.5 vs 4.6 mU/L), as well as lower levels of high-density lipoprotein cholesterol (59.9 ± 18.0 vs 69.0 ± 17.1 mg/dl), SHBG (44.6 vs 68.1 nmol/L) and the quantitative insulin sensitivity check index (0.66 ± 0.41 vs 0.93 ± 0.73). Multivariate analysis by logistic regression identified age (odds ratio [OR] 1.22, 95% confidence intervals [CI] 1.09 to 1.37), smoking (OR 11.46, 95% CI 2.56 to 51.39), SHBG (OR 0.98, 95% CI 0.96 to 0.99), and apolipoprotein B (OR 1.02, 95% CI 1.01 to 1.04) as independently associated with the presence of CHD. Thus, low plasma levels of SHBG are associated with CHD in women independently of insulin, obesity markers, and dyslipidemia.

Physical Activity and Coronary Heart Disease in Women: Is “No Pain, No Gain” Passe?

AORN JournalVolume 76, Issue 2 p. 331-331 Review Physical Activity and Coronary Heart Disease in Women: Is “No Pain, No Gain” Passe? Mary Lynne Weemering RN, MSN, CNOR, Mary Lynne Weemering RN, MSN, CNOR NURSING RESEARCH COMMITTEESearch for more papers by this author Mary Lynne Weemering RN, MSN, CNOR, Mary Lynne Weemering RN, MSN, CNOR NURSING RESEARCH COMMITTEESearch for more papers by this author First published: 01 August 2002 https://doi.org/10.1016/S0001-2092(06)61076-4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume76, Issue2August 2002Pages 331-331 RelatedInformation

Retinal arteriolar narrowing and risk of coronary heart disease in men and women: The Atherosclerosis Risk in Communities Study. Wong TY, Klein R, Sharrett AR, Duncan BB, Couper DJ, Tielsch JM, Klein BEK, Hubbard LD. JAMA 2002;287:1153–1159.

Microvascular processes have been hypothesized to play a greater role in the development of coronary heart disease (CHD) in women than in men; however, prospective clinical data are limited. The authors examined the association between retinal arteriolar narrowing, a marker of microvascular damage from hypertension and inflammation, and incident CHD in healthy middle-aged women and men. The Atherosclerosis Risk in Communities Study is an ongoing prospective, population-based cohort study in four US communities initiated in 1987 to 1989. Retinal photographs were taken in 9648 women and men aged 51 to 72 years without CHD at the third examination (1993–1995). To quantify retinal arteriolar narrowing, the photographs were digitized, individual arteriolar and venular diameters were measured, and a summary arteriole-to-venule ratio (AVR) was calculated. During an average 3.5 years of follow-up, 84 women and 187 men experienced incident CHD events. In women, after controlling for mean arterial blood pressure averaged over the previous six years, diabetes, cigarette smoking, plasma lipid levels, and other risk factors, each standard deviation decrease in the AVR was associated with an increased risk of any incident CHD and of acute myocardial infarction. In contrast, AVR was unrelated to any incident CHD in men or to acute myocardial infarction. The authors conclude that retinal arteriolar narrowing is related to risk of CHD in women but not in men, supporting a more prominent microvascular role in the development of CHD in women than in men.—Thomas J. Liesegang

Perception of risk for coronary heart disease in women undergoing coronary angiography

Background: Even though coronary heart disease (CHD) is the leading cause of death among women in the United States, most women underestimate their risk of developing CHD. Design: Survey to examine the relationship between women's recollection of being told they were at risk for CHD and the presence of risk factors. Setting/Participants: A convenience sample of 450 women undergoing coronary angiography at 1 university hospital. Main Outcome Measures: Self-recollection of being told one was at risk for CHD and presence of CHD risk factors. Results: Most women (83.6%) had 3 or more risk factors, 12.2% had 1 or 2 risk factors, and 0.9% had no risk factors. Only 35% of women recalled being told that they were at risk for CHD. Few relationships were found between being told one was at risk for CHD and the presence of individual risk factors. No difference was found in the mean number of risk factors among women who did and did not recall being told they were at risk. In logistic regression analysis, only 5% of the variance in recollection of being told one was at risk was predicted, with only age, education, and having a high cholesterol level significantly contributing to the equation. Conclusions: Even though women may not remember conversations with their health care provider about CHD risk, the possibility that risk factors were not adequately assessed cannot be discounted. Patient-provider conversations about CHD risk factors should be encouraged as the first step toward successful risk reduction. (Heart Lung® 2002;31:246-52.)

Coronary heart disease: Women's assessment of risk--a qualitative study

Coronary heart disease (CHD) kills over 135,000 people each year. The underlying premise of this study was that women might not assess themselves as at risk because CHD has generally been perceived within popular culture, medicine and research as a man's disease. Hayes ( Social Science and Medicine, 35, pp. 55-61, 1991) suggests that critical to the success of any risk assessment strategy is: the identification of risk markers that can accurately predict specific adverse health outcomes and the ability of the strategy users to measure risk factors and calibrate them appropriately. In-depth interviews were conducted with 83 women, 50 who had been admitted to hospital with a CHD-related cardiac event and 33 without manifest CHD. They were found to adopt risk assessment strategies that enabled them to conceptually distance themselves from risk of CHD by: attributing risky lifestyle behaviour to men; subjectively manipulating the potential threat posed by their own risk factors and by over-emphasising the importance of social position to risk. The outcome of these strategies can be summed up as--'women are only at high risk of developing CHD if they adopt a man's way of life'. This has important implications for the prevention of CHD in women.

Fish and omega-3 fatty acid intake and risk of coronary heart disease in women

Fish and omega-3 fatty acid intake and risk of coronary heart disease in women

Retinal arteriolar narrowing and risk of coronary artery disease in men and women. The Atherosclerosis Risk in Communities Study.Wong TY, Klein R, Sharrett AR, Duncan BB, Couper DJ, Tielsch JM, Klein BEK, Hubbard LD. JAMA 2002;287:1153–1159.

The relative contribution of microvascular and macrovascular processes to the risk of coronary heart disease (CHD) is unknown, but evidence suggests that both contribute to some degree. Microvascular processes have been hypothesized to play a greater role in the development of CHD in women than in men, although prospective clinical data are limited. Since retinal arteriolar narrowing is a marker of microvascular damage, typically from hypertension, it was suggested that there might be an association between retinal arteriolar narrowing and CHD. As part of the Atherosclerosis Risk in Communities Study, an ongoing prospective, population-based cohort study in four US communities initiated in 1987 to 1989, retinal photographs were taken in 9,648 women and men aged 51 to 72 years without CHD at the third examination (1993–1995). To quantify retinal arteriolar narrowing, the photographs were digitized, individual arteriolar and venular diameters were measured, and a summary arteriole-to-venule ratio (AVR) was calculated. During an average 3.5 years of follow-up, 84 women and 187 men experienced incident CHD events. In women, after controlling for mean arterial blood pressure averaged over the previous six years, diabetes, cigarette smoking, plasma lipid levels, and other risk factors, each SD decrease in the AVR was associated with an increased risk of any incident CHD and of acute myocardial infarction. In contrast, AVR was unrelated to any incident CHD in men or to acute myocardial infarction. The authors conclude that retinal arteriolar narrowing is related to risk of CHD in women but not in men, supporting a more prominent microvascular role in the development of CHD in women than in men. However, future studies are needed to confirm these findings.—Nancy J. Newman

Fish and Omega-3 Fatty Acid Intake and Risk of Coronary Heart Disease in Women

Higher consumption of fish and omega-3 fatty acids has been associated with a lower risk of coronary heart disease (CHD) in men, but limited data are available regarding women. To examine the association between fish and long-chain omega-3 fatty acid consumption and risk of CHD in women. Dietary consumption and follow-up data from 84 688 female nurses enrolled in the Nurses' Health Study, aged 34 to 59 years and free from cardiovascular disease and cancer at baseline in 1980, were compared from validated questionnaires completed in 1980, 1984, 1986, 1990, and 1994. Incident nonfatal myocardial infarction and CHD deaths. During 16 years of follow-up, there were 1513 incident cases of CHD (484 CHD deaths and 1029 nonfatal myocardial infarctions). Compared with women who rarely ate fish (<1 per month), those with a higher intake of fish had a lower risk of CHD. After adjustment for age, smoking, and other cardiovascular risk factors, the multivariable relative risks (RRs) of CHD were 0.79 (95% confidence interval [CI], 0.64-0.97) for fish consumption 1 to 3 times per month, 0.71 (95% CI, 0.58-0.87) for once per week, 0.69 (95% CI, 0.55-0.88) for 2 to 4 times per week, and 0.66 (95% CI, 0.50-0.89) for 5 or more times per week (P for trend =.001). Similarly, women with a higher intake of omega-3 fatty acids had a lower risk of CHD, with multivariable RRs of 1.0, 0.93, 0.78, 0.68, and 0.67 (P<.001 for trend) across quintiles of intake. For fish intake and omega-3 fatty acids, the inverse association appeared to be stronger for CHD deaths (multivariate RR for fish consumption 5 times per week, 0.55 [95% CI, 0.33-0.90] for CHD deaths vs 0.73 [0.51-1.04]) than for nonfatal myocardial infarction. Among women, higher consumption of fish and omega-3 fatty acids is associated with a lower risk of CHD, particularly CHD deaths.