Risk Factors In Premenopausal Women Research Articles

RISK FACTOR PROFILING OF ACUTE CORONARY SYNDROME IN PREMENOPAUSAL WOMEN PRESENTING AT A TERTIARY CARE HOSPITAL IN URBAN INDIAN SETTING: AN OBSERVATIONAL STUDY

Objective: This study aimed to evaluate cardiovascular risk factors in premenopausal women presenting with acute coronary syndrome (ACS). Design and method: Premenopausal women presenting with ACS at the Deenanath Mangeshkar hospital & research center, Pune between January 2012 and June 2019 were enrolled. Data concerning demographics, risk factors and medical history (self-reported) were collected. Results: Ninety premenopausal women (mean age: 40.8 ± 5.0 years) were included in the study. The most common presenting symptoms were chest pain (83.3%) and shortness of breath. ACS presentation included ST-elevation myocardial infarction (38.9%), unstable angina (34.4%) and non-ST-elevation myocardial infarction (25.6%). Mild-to-severe left ventricular dysfunction was seen in 52.2% women and triple or double vessel disease in 52.2% women. The most frequent conventional coronary risk factors were diabetes (of total 41%, 48. 6% were poorly controlled) and hypertension (38.9%); lifestyle-related risk factor were low levels of physical activity (51.1%); and obstetric and gynaecological factors were history of at least one miscarriage (26.7%) and hormonal contraceptive use (26.7%). No correlation was found between the risk factors and presentation of ACS or severity of coronary artery disease. Conclusions: The high prevalence of conventional risk factors need to be identified and addressed early. Novel gynaecological risk factors are often ignored and need fair attention in routine practice in premenopausal women presenting with ACS. To our knowledge, this is one of the largest data set that determined cardiovascular risk factors in premenopausal women with ACS.

Reassessment of prevalence of tubal endometriosis, and its associated clinicopathologic features and risk factors in premenopausal women received salpingectomy.

IntroductionTo reassess the prevalence of fallopian tube endometriosis (EM), and its associated clinicopathologic characteristics and risk factors.MethodsCross-sectional study was conducted from June 2016 to August 2017. Unpregnant premenopausal women who underwent unilateral or bilateral salpingectomy due to gynecologic diseases were recruited. Patient clinical data and fallopian tube specimens were collected. Hematoxylin-eosin (H&E) staining and CD10 immunohistochemistry were used to diagnose tubal EM.ResultsTubal EM prevalence was 14.48% (161/1112, 95% confidence interval [CI] 12.41%–16.55%). Prevalence of tubal EM in patients with EM was 37.37% (95%CI 30.58%–44.17%) which is higher in patients without EM (9.52%, 95%CI 7.61%–11.42%) and even higher in those with multi-organ EM (43.94%, 95%CI 35.36%–52.52%). At unilateral or bilateral salpingectomy, tubal EM was more likely located in the left fallopian tube (52.17%) than the right one (40.37%) and presence of hydrosalpinx/ hematosalpinx increased in women with tubal EM than without tubal EM (43.47% versus 23.79%). With increasing severity of pelvic EM (r = 0.26, P<10−4) and adhesion (r = 0.25, P<10−4), the tubal EM prevalence also increased. Pathological examination found that tubal EM was more likely located in the mucosa of the proximal tube with significantly more surrounding inflammation and fibrotic lesions than the serosa/sub-serosa in the distal tube (r = 0.90, P<10−4). Multivariate analysis showed that abnormal uterine bleeding (AUB) (AOR = 3.10), previous EM surgery (AOR = 4.22) and tubal ligation (AOR = 2.33) were risk factors for tubal EM.ConclusionsThese data provide clinicians with important information that the prevalence of tubal EM among premenopausal unpregnant patients was higher than previous investigators, especially higher among women with EM diseases. Identifying its clinicopathologic characteristics and predictors may facilitate clinical decision making.

Influence of cardiorespiratory fitness and physical activity levels on cardiometabolic risk factors during menopause transition: A MONET study

To determine the influence of cardiorespiratory fitness (hereafter “fitness”) and physical activity levels on cardiometabolic risk factors in premenopausal women going through the menopause transition. An ancillary study including 66 premenopausal women who participated to a 5-year observational, longitudinal study (2004 to 2009 in Ottawa) on the effects of menopause transition on body composition and cardiometabolic risk factors. Women underwent a graded exercise test on treadmill to measure peak oxygen uptake (VO2 peak) at year 1 and 5 and physical activity levels were measured using accelerometers. Cardiometabolic risk factors included: waist circumference, fasting plasma lipids, glucose and insulin levels, HOMA-IR score, c-reactive protein, apolipoprotein B (apoB) and resting systolic and diastolic blood pressure. Change in fitness was not associated with changes in cardiometabolic risk factors. The changes in total physical activity levels on the other hand showed a significant negative association with apoB levels. Three-way linear mixed model repeated measures, showed lower values of waist circumference, fasting triglycerides, insulin levels, HOMA-IR score, apoB and diastolic blood pressure in women with a fitness ≥ 30.0 mlO2 kg− 1 min− 1 compared to women with a fitness < 30.0 mlO2 kg− 1 min− 1 (P < 0.05). However, only fasting triglycerides was lower in women with physical activity levels ≥ 770.0 Kcal/day (P < 0.05). Between fitness and physical activity levels, fitness was associated with more favorable values of cardiometabolic risk factors in women followed for 5 years during the menopause transition.

Effects of a Multi-Disciplinary Lifestyle Intervention on Cardiometabolic Risk Factors in Young Women with Abdominal Obesity: A Randomised Controlled Trial.

BackgroundYoung women are under-represented in cardiovascular disease research, with obesity and cardiometabolic risk factor interventions generally targeting older adults. Furthermore, appropriate study designs for young women remain uncertain. This study aimed to assess the impact of a 12 week multi-disciplinary lifestyle intervention on cardiometabolic risk factors in premenopausal women with abdominal obesity.MethodsWomen aged 18–30 y with abdominal obesity [waist circumference (WC) ≥ 80 cm] were randomised to a 12 week lifestyle intervention (n = 26) of physical activity, nutrition education and cognitive behavioural therapy, or a wait-list control group (n = 17). Both groups completed anthropometric, biochemical, nutrition and fitness testing, at pre (0 weeks) and post (12 weeks), with intervention participants completed follow-up testing at 24 weeks.ResultsResults from a linear mixed model showed no between-group differences, other than increased physical activity in the intervention group, at post. In the intervention group alone, positive within-group changes were observed in WC, waist-hip-ratio (WHR), waist-height-ratio (WHtR), resting heart rate, blood pressure, predicted VO2max, and total energy intake. Most changes were maintained at 24 weeks post-intervention. Similar within-group improvements were observed in control participants in WC, WHR, WHtR, and systolic blood pressure but no changes were detected in physical activity and nutrition.ConclusionsCardiometabolic risk factors were decreased as a result of a lifestyle intervention in young women with abdominal obesity. It is difficult to describe observations in the control group without greater understanding of the behaviour of wait-list participants.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12612001017819

Effect of vitamin D supplementation on cardiometabolic risks and health-related quality of life among urban premenopausal women in a tropical country--a randomized controlled trial.

BackgroundMany observational studies linked vitamin D to cardiometabolic risks besides its pivotal role in musculoskeletal diseases, but evidence from trials is lacking and inconsistent.AimTo determine whether Vitamin D supplementation in urban premenopausal women with vitamin D deficiency can improve cardiometabolic risks and health-related quality of life (HRQOL).DesignA double-blind randomized controlled trial was conducted in Kuala Lumpur, Malaysia. A total of 192 vitamin D deficient (<50 nmol/l) premenopausal women were randomized to receive either vitamin D 50,000 IU or placebo once a week for 2 months and then monthly for 10 months. Primary outcomes were serum 25(OH)D, serum lipid profiles, blood pressure and HOMA-IR measured at baseline, 6 months and 12 months. HRQOL was assessed with SF-36 at baseline and 12 months.ResultsNinety three and ninety-nine women were randomised into intervention and placebo groups respectively. After 12 months, there were significant differences in the serum 25(OH)D concentration (mean difference: 49.54; 95% CI: 43.94 to 55.14) nmol/l) and PTH levels (mean difference: −1.02; 95% CI: −1.67 to −0.38 pmol/l) in the intervention group compared to placebo group. There was significant difference between treatment group in both serum 25(OH)D and PTH. There was no effect of supplementation on HOMA-IR, serum lipid profiles and blood pressure (all p>0.05) between two groups. There was a small but significant improvement in HRQOL in the components of vitality (mean difference: 5.041; 95% CI: 0.709 to 9.374) and mental component score (mean difference: 2.951; 95% CI: 0.573 to 5.329) in the intervention group compared to placebo group.ConclusionLarge and less frequent dosage vitamin D supplementation was safe and effective in the achievement of vitamin D sufficiency. However, there was no improvement in measured cardiometabolic risk factors in premenopausal women. Conversely vitamin D supplementation improves some components of HRQOL.Trial RegistrationAustralian New Zealand Clinical Trial Registry ACTRN12612000452897

Metabolic response to 6-week aerobic exercise training and dieting in previously sedentary overweight and obese pre-menopausal women: A randomized trial

BackgroundThe aim of this study was to compare 6 weeks short-term moderate intensity aerobic exercise and dieting on serum metabolomics and cardio-metabolic risk factors in pre-menopausal women. MethodsNinety previously inactive overweight and obese (BMI 25–35 kg/m2) women (age 41.5 ± 7.6 years) were randomized to either a 6-week Nordic walking exercise program (EX, n = 45) or dietary counseling group (DI, n = 45). Body composition, serum glucose, insulin and lipids were measured. Serum low-molecular-weight metabolites and lipid constituents were analyzed by nuclear magnetic resonance spectroscopy. Measurements were done at baseline and 7 days after the last training session. ResultsSix weeks aerobic exercise program yielded reductions in serum free fatty acids (−34.7%, 95% confidence interval (CI), −50 to −18, p < 0.001), glucose (−9.6%, 95%CI, −15 to −4, p < 0.001) and homeostasis model assessment of insulin resistance (HOMA-IR) (−28.7%, 95%CI, −48 to −10, p = 0.005) without changes in body weight or fat mass. Diet counseling resulted in loss of body weight (1.5%, 95%CI, −2.3 to −0.7, p = 0.001) but no changes in free fatty acids, fasting glucose, or HOMA-IR were found. ConclusionOur results indicate that small weight loss does not produce measurable health benefits, whereas short-term regular aerobic exercise can improve glucose and lipid metabolism even in the absence of weight loss in previously sedentary overweight and obese women.

Sex hormones and risk of breast cancer in premenopausal women: a collaborative reanalysis of individual participant data from seven prospective studies

Associations between circulating concentrations of oestrogens, progesterone, and androgens with breast cancer and related risk factors in premenopausal women are not well understood. We aimed to characterise these associations with a pooled analysis of data from seven studies. Individual participant data for prediagnostic sex hormone and sex hormone-binding globulin (SHBG) concentrations were contributed from seven prospective studies. We restricted analyses to women who were premenopausal and younger than 50 years at blood collection, and to women with breast cancer diagnosed before age 50 years. We estimated odds ratios (ORs) with 95% CIs for breast cancer associated with hormone concentrations by conditional logistic regression in cases and controls matched for age, date of blood collection, and day of cycle, with stratification by study and further adjustment for cycle phase. We examined associations of hormones with risk factors for breast cancer in control women by comparing geometric mean hormone concentrations in categories of these risk factors, adjusted for study, age, phase of menstrual cycle, and body-mass index (BMI). All statistical tests were two-sided. We included data for up to 767 women with breast cancer and 1699 controls in the risk analyses. Breast cancer risk was associated with a doubling in concentrations of oestradiol (OR 1·19, 95% CI 1·06-1·35), calculated free oestradiol (1·17, 1·03-1·33), oestrone (1·27, 1·05-1·54), androstenedione (1·30, 1·10-1·55), dehydroepiandrosterone sulphate (1·17, 1·04-1·32), testosterone (1·18, 1·03-1·35), and calculated free testosterone (1·08, 0·97-1·21). Breast cancer risk was not associated with luteal phase progesterone (doubling in concentration OR 1·00, 95% CI 0·92-1·09), and adjustment for other factors had little effect on any of these ORs. Cross-sectional analyses in control women showed several associations of sex hormones with breast cancer risk factors. Circulating oestrogens and androgens are positively associated with the risk for breast cancer in premenopausal women.

Increased free androgen index is associated with hypertension in premenopausal women

Objective: Increased testosterone and decreased sex hormone-binding globulin (SHBG) are associated with a number of adverse cardiovascular risk factors in postmenopausal women. The aim of this population-based study of women aged 25 to 50 was to assess the relationship between free androgen index (FAI) and cardiovascular risk factors in premenopausal women. Methods: A population-based survey of 396 premenopausal women with no hormonal treatment was undertaken as part of the Northern MONICA study. The study involved questionnaires, anthropometry and assays of testosterone and SHBG. Results: Increased FAI was associated with a number of cardiovascular risk factors in premenopausal women but this relationship was strongly affected by body mass index (BMI). After adjustment for age and BMI, FAI was significantly associated with increased systolic and diastolic blood pressures. Conclusion: Hyperandrogenism is associated with increased blood pressure and these findings emphasize the need to assess cardiovascular risk factors in women with hyperandrogenism of all ages.

Abstract P3-11-01: Longitudinal Changes in Mammographic Features and Subsequent Risk of Breast Cancer in Pre-Menopausal Women: Studies Nested within the Age Trial

Abstract Background: Mammographic percent density (PD) is one of the strongest known risk factors for breast cancer, with women with 75% or more density having approximately 4 times greater risk of developing breast cancer than those with little density (&amp;lt;5%). Most studies have been conducted in peri-and post-menopausal women with very few studies of density in younger pre-menopausal women. Mammographic features change throughout a woman's lifetime, with the amount of stromal and epithelial tissue decreasing with age, parity and the menopause. As some of the greatest changes in density occur during the menopause, it would be very informative to know whether PD measured at a younger age or the rate of change in PD could be better predictors of subsequent breast cancer risk. Methods: A nested case-control study of 350 cases and 450 controls was conducted within the intervention arm of the Age Trial of mammographic screening in young women, in which about 54,000 women wererandomised to receive yearly mammographic screening from ages 40 to 48. Women diagnosed with breast cancer were invited to participate in the study, and for each case, healthy controls were randomly selected matched to the cases on screening centre, age and date of mammogram. We are investigating how changes in PD over time in pre-menopausal women, measured on digitised films using a computer-assisted threshold method, relate to subsequent risk of breast cancer. Additionally, we are looking at associations of risk factor variables with baseline PD and changes in PD, investigated in longitudinal analyses in a sample of over 500 breast cancer-free women. Logistic regression models were used to estimate the effect of baseline mammographic density on subsequent breast cancer risk and multilevel linear models to assess the association between longitudinal changes in percent density and risk of breast cancer. Results: Over a 10 year period between ages 40 and 50, the mean reduction in percent density was 10.9% in our sample of breast cancer-free women. Change in percent density was greatest in the women's early forties, with a decrease of 1.9% per year, which reduced to about 0.2% in their late forties/early fifties. Baseline levels and rate of change of percent density were both associated with current and past anthropometric, reproductive and lifestyle factors. Change in percent density was associated with parity, with women who had three or more children experiencing a slower rate of change (P&amp;lt;0.01), and with body mass index (BMI), with extremely overweight women at baseline (&amp;gt;28 kg/m2) having a slower decline in PD than women of normal BMI (22-24 kg/m2). The analysis of the case-control data is currently in progress. Conclusion: We demonstrated that change in PD was associated with known breast cancer risk factors in pre-menopausal women. The results from the nested case-control study will further our understanding of the life-course trajectory of mammographic density and its role as a mediator of breast cancer risk. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-11-01.

E0389 Clinical profile of premenopausal women with coronary heart disease

ObjectiveTo study the clinical profile of premenopausal women with coronary heart disease.Methods116 premenopausal women with chest pain were classified into coronary heart disease group and control group by coronary angiography....

Relationship between the percentage of predicted cardiorespiratory fitness and cardiovascular disease risk factors in premenopausal women: a MONET study

Objective To determine the relationships between the percentage predicted cardiorespiratory fitness (%CRF) and the anthropometric and metabolic cardiovascular disease risk factors in asymptomatic, premenopausal women.Methods Data are baseline values obtained in 97 healthy premenopausal women (age 49.9 ± 1.9 years; body mass index 23.2 ± 2.2 kg/m2) participating in a longitudinal study from 2004 to 2009. The outcome measures were peak oxygen consumption (VO2 peak), body mass index, body composition (percentage fat, fat mass, fat-free mass), waist circumference, abdominal subcutaneous fat, visceral fat, resting blood pressure and fasting lipids, glucose and insulin levels.Results The %CRF was negatively associated with body mass index, fat mass, percentage fat, waist circumference, abdominal subcutaneous fat, visceral fat, triglycerides, triglyceride/high density lipoprotein cholesterol, total cholesterol, total cholesterol/high density lipoprotein cholesterol, fasting insulin levels and HOMA-IR (− 0.59 ≤ r ≤ − 0.20; 0.01 < p < 0.05) and positively associated with insulin sensitivity index (r = 0.23; p < 0.05). VO2 peak was associated with the same variables; however, correlations were slightly better (− 0.70 ≤ r ≤ 0.30; 0.01 < p < 0.05). Stepwise multiple regression analysis showed that %CRF was only independently correlated with plasma triglyceride levels.Conclusion The results of this study suggest that %CRF was not a major predictor of anthropometric and metabolic variables associated with an increased risk of cardiovascular disease in asymptomatic premenopausal women. Finally, the VO2 peak is a better predictor than the %CRF to assess the risk of cardiovascular disease in asymptomatic premenopausal women.

Adiponectin Concentrations Are Associated With Cardiovascular Disease Risk Factors In Pre-menopausal Women

Adiponectin Concentrations Are Associated With Cardiovascular Disease Risk Factors In Pre-menopausal Women

Relationship between the percentage of predicted cardiorespiratory fitness and cardiovascular disease risk factors in premenopausal women: a MONET study

Relationship between the percentage of predicted cardiorespiratory fitness and cardiovascular disease risk factors in premenopausal women: a MONET study

Risk Factors For Heart Disease In Women Living In Rural And Urban Areas In Sinaloa, Mexico

Cardiovascular disease (CVD) is still the mayor cause of death in Mexico. In Sinaloa, Mexico, there are no reported studies regarding the prevalence of biomarkers or anthropometric measurements associated with CVD. The aim of this study was to determine the presence of these risk factors in pre-menopausal women from two urban and rural areas. 224 women, distributed into 4 groups participated. Urban: 24 from Mazatlán and 36 from Culiacán, rural: 52 from S. Leyva and 32 from Cosala. A 12 h fast blood sample was drawn from each participant to analyze total cholesterol (TC), LDL cholesterol (LDL-C) HDL cholesterol (HDL-C), triglycerides (TAG) and glucose. The metabolic syndrome was defined as having three or more of the risk factors postulated by the ATP-III. All participants were overweight or obese with a waist circumference greater than 88 cm. All participants had TC > 200 and LDL-C >120 mg/dL. HDL-C concentrations were significantly lower (P < 0.01) in Culiacán (47.1 ±9.1 mg/dL) and Mazatlan (49.3 ± 13.9 mg/dL) compared to the rural areas. Urban women had higher plasma glucose concentrations compared to rural women (P < 0.05). The prevalence of the metabolic syndrome was high in all the participants with 36, 25, 21 and 25 % of cases in Culiacán, Mazatlán, S. Leyva and Cosala, respectively. The most frequently consumed foods by these women are: soda, corn tortilla, sugar, fried potatoes, tomatoes, cheese, refried beans, eggs, and fatty meat. From these studies we conclude that CVD risk factors are high among women from Sinaloa and that their diet might contribute to the presence of some of these factors.

Hypertension, Menopause, and Coronary Artery Disease Risk in the Women’s Ischemia Syndrome Evaluation (WISE) Study

We evaluated whether the relationship between hypertension, other cardiac risk factors, and coronary artery disease (CAD) is modulated by menopausal status and/or age. The relative contribution of age versus menopausal status in the development of CAD in women remains unclear. We compared systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and traditional cardiac risk factors for CAD in premenopausal (n = 123) and postmenopausal (n = 482) women undergoing coronary angiography for suspected ischemia. To assess the relative contribution of age versus menopausal status, we fit a hypertension-menopausal status interaction term and adjusted for age. There were similar relationships with regard to traditional coronary risk factors and angiographic CAD in premenopausal versus postmenopausal women, with few exceptions. Twenty percent of premenopausal women had angiographic CAD versus 31% of postmenopausal women (p = 0.02). Premenopausal women had lower mean (standard deviation) SBP (132 [25] vs. 139 [20] mm Hg; p < 0.0001) and lower PP (54 [18] vs. 62 [18] mm Hg; p < 0.0001) compared to postmenopausal women; however, multivariable analyses revealed that SBP was a risk factor for CAD in premenopausal (p = 0.002) but not postmenopausal women (p = 0.13), and regression slopes were significantly different (p = 0.04). This interaction effect remained after age adjustment, suggesting independent risk contribution from both age and menopausal status. A similar slope difference was observed for PP (p = 0.03) but not for DBP. Among women undergoing angiography for suspected ischemia, elevated SBP and PP are potent risk factors in premenopausal women. The results suggest that identification of hypertension in premenopausal women dictates additional CAD risk factor assessment and management.

Why is cardiovascular health important in menopausal women?

Since endogenous estrogen shows some preventative benefits against cardiovascular risk factors in premenopausal women, cardiovascular disease (CVD) is often considered a male disease. However, CVD is the biggest cause of death in women, especially after menopause when endogenous estrogen withdrawal has detrimental effects on cardiovascular physiology and whole-body metabolism. Despite this, awareness of the risk of CVD is low in both women and in doctors; this needs rectifying. Women are under-represented in most clinical studies of CVD. Following diagnosis of CVD, the prognosis for women is not systematically similar to that for men. Furthermore, from the few comparisons conducted, gender differences in response to pharmacological interventions are evident, so that results obtained in wholly or largely male-based studies cannot be systematically extrapolated to women. Women with CVD should be afforded equivalent investigations and treatment to men, and it is vital that women be included in clinical trials in sufficient numbers to allow sub-group analyses and subsequent development of appropriate therapies. Since CVD is usually advanced by the time symptoms appear, prevention is the key; health management advice might include smoking cessation, adoption of a healthy diet, and incorporation of physical activity into the lifestyle.

Relationship between premenopausal cardiovascular risk & brachial artery distensibility in postmenopausal women

Previous studies have demonstrated that premenopausal women are at reduced risk for cardiovascular (CV) disease, in contrast to postmenopausal women. However, limited data is available on the relationship between early carotid atherosclerosis and CV risk factors in premenopausal women, and peripheral artery distensibility (DIST) post menopause. We evaluated 187 postmenopausal women (mean age 59) for brachial artery DIST using pulse dynamic calibrated arterial pressure waveforms obtained by a cuff sphygmomanometer. The method has been previously documented. Risk factors such as blood pressure, fasting insulin, 2-hour glucose tolerance, serum lipids, and alcohol intake were obtained prior to menopause. Presence of early carotid atherosclerosis was determined using intimal-medial thickness (IMT) and plaque index obtained by ultrasound. Univariate analysis demonstrated that higher DIST was associated with lower premenopausal SBP (r=−0.28, p=0.0001), 2-hour glucose tolerance (r=−0.20, p=0.005), fasting insulin (r=−0.16, p=0.03), and triglycerides (r=−0.15, p=0.03). Alcohol consumption demonstrated an interesting trend (r=0.14, p=0.06). Carotid artery IMT (r=−0.20, p<0.005) and plaque index (r=−0.18, p=0.013) also correlated significantly. A log transformation was used to approximate a normal distribution for DIST In multivariate linear regression, controlling for age, independent predictors of DIST were lower SBP (p<0.001), lower 2-hour glucose tolerance (p=0.040), and lower alcohol intake (p=0.043). When carotid IMT was added to the model, thicker walls were associated with lower DIST, and this was borderline significant (p=0.075). Thus, we conclude that in healthy middle-aged women, premenopausal values for SBP, 2-hour glucose tolerance, and alcohol consumption are associated with a degree of vascular DIST measured 8 years post menopause.

Comparison of Waist to Hip Ratio Sites and Heart Disease Risk Factors in Healthy Premenopausal Women

LEARNING OUTCOME: To identify the recommended waist to hip ratio measurement method for determination of upper body fat distribution. Upper body fat distribution (UBFD) is associated with an increased risk for cardiovascular disease (CVD). Women with UBFD often have low HDL-cholesterol levels, hypertriglyceridemia, and hypertension. The waist to hip ratio (WHR) is a useful screening tool to determine UBFD and potential CVD risk. A WHR in women of >0.8 is indicative of UBFD. Currently, there is no agreement regarding which anatomical sites most effectively identify UBFD. The purpose of this study was to determine which of four commonly used WHR waist sites correlated best with CVD risk factors in premenopausal women. Forty healthy females (aged 34.3±10.7 yrs.) volunteered for this study. Diastolic blood pressure (DBP), fasting lipids [HDL-cholesterol (HDL) and triglycerides (TG)], and percent body fat (%BF) were determined. Four waist sites were measured: WHR 1 - smallest waist; WHR 2 - midway between the lowest rib and anterior superior iliac spine: WHR 3 - umbilicus; and WHR 4 –1/3 the distance between the xiphoid process and the umbilicus. Maximum extension of the buttocks was used for the hip site. The group mean for %BF was 29.5±7%, DBP was 73.7±8.1 mmHg, HDL was 70.2±17.7 mg/dl, and TG was 106.9±56.1 mg/dl. The average WHRs varied with each site used; WHR 1,2,3, and 4 averaged 0.77, 0.82, 0.88, and 0.80, respectively. Pearson product moment correlation coefficients determined that WHR 2 correlated (p<0.05) with DBP (r=0.36) and HDL (r=−0.36) but not with TG. WHR 3 correlated with DBP (r=0.45) and TG (r=0.42) but not with HDL. In identifying the sensitivity of a specific WHR measure as an acceptable screening tool for CVD risk, we examined whether the individuals identified by a given WHR as having UBFD also had either high TGs, low HDLs. or high DBP. We called this a true positive (TP) finding; false positive (FP) findings meant subjects had WHR >0.8 but no CVD risks. We accepted WHR2 as being the best measure because it had a high TP rate (86%) and a low FP rate (45%). We recommend WHR2 as the best site to identify UBFD and potential risk for CVD.

The Effects of a Two-Year Education Program on Cardiovascular Disease Risk Factors in Pre-menopausal Women

LEARNING OUTCOME: To understand which cardiovascular disease risk factors are most likely to be affected by education and at which time periods these effects are greatest for pre-menopausal Midwestern women. Cardiovascular disease (CVD) risk assessment and reduction are important issues concerning women's health in the U.S. The objective of this study was to determine whether a two-year education program would decrease CVD risk in pre-menopausal women. Two hundred eighty-two pre-menopausal women were recruited through Cooperative Extension Service at seven Illinois sites. Half served as controls receiving no educational intervention. The intervention consisted of six monthly education sessions, followed by 6 months of fact sheet mailings. Four educational follow-up sessions were provided in year two. CVD risk factor assessment data was collected at baseline and 6, 12, 24 months. CVD risk was calculated based upon body mass index (BMI) >25, % body fat >30%, waist-to-hip ratio >0.8, and % intake of calories from fat > 30%. T-tests were used to determine differences between mean scores for treatment (T) and control (C) groups; repeated measures analysis for differences within a group over time. At baseline, 45% had a BMI > 25; 48% were consuming > 30% of calories as fat; 25% had a waist:hip ratio > 0.8; and 74% had a body fat percentage > 25. There were no significant differences (p<0.05) between T and C mean risk factor values at baseline or at 6 months. At 12 and 24 months there were no significant differences between T and C for any mean risk factor value except waist-to-hip ratio (p=0.047;p=0.02). However, the percentage of women for whom fat intake was a risk fell 29% and 49% at 12 and 24 months, respectively in T, but only 18% and 30% for C. For data baseline to 12 months, repeated measures analysis was significant (p=0.00) only for T group's percent calories from fat and for C group's percent body fat. For baseline data to 24 months, only C group's % body fat was significant (p=0.03). In conclusion, CVD risk factors are prevalent in pre-menopausal women. Sustained educational programs can modify dietary fat intake, both in mean values and the percentage of women for whom fat intake is a risk.

Sex specific issues relating to nuclear cardiology.

Coronary heart disease is a major source of morbidity and mortality in women. Despite the importance of this health problem, women in general have not received the same degree of aggressiveness in diagnosis and treatment as men have received. Contributing to underdiagnosis and undertreatment in women include the results of the Framingham study, which showed that women with angina have better prognoses than men, and the results of multicenter percutaneous transluminal coronary angioplasty and coronary artery bypass grafting trials, which showed that women have higher morbidity and mortality rates in the periprocedure periods. These higher morbidity and mortality rates can largely be explained by the older ages of women when they have symptomatic coronary heart disease and the attendant higher incidence of comorbid diseases in an elderly population. Because of the cardiovascular protective effects of estrogen, the incidence of disease of the epicardial coronary arteries in the absence of significant risk factors in premenopausal women is very low despite the fairly high incidence of chest pain syndromes. Some of these women may have endothelial dysfunction, some small vessel disease, and some may have the visceral pain syndrome. When coronary heart disease does present in middle-aged women, it tends to be less severe than in middle-aged men. The recognized limitations of stress perfusion imaging in single vessel disease, as well as resolution limitations in small hearts and limitations due to soft tissue attenuation artifacts, all must be considered when imaging women. Applications of nuclear techniques to some of the unique aspects of chest pain in women such as small vessel disease or endothelial dysfunction represent as yet unmet challenges.