Download PDF
Dtsch Med Wochenschr 2003; 128(31/32): 1659-1664
DOI: 10.1055/s-2003-41103
Übersichten
© Georg Thieme Verlag Stuttgart · New York

Kardiovaskuläre Risikofaktoren bei Frauen

Cardiovascular risk factors in womenV. Stangl1 , G. Baumann1 , K. Stangl1
  • 1Med. Klinik mit Schwerpunkt Kardiologie, Angiologie, Pneumologie (Direktor: Prof. Dr. med. Gert Baumann), Charité der Humboldt-Universität, Campus Mitte
Further Information

Publication History

eingereicht: 10.1.2003

akzeptiert: 29.4.2003

Publication Date:
01 August 2003 (online)

Also available at
    Permissions and Reprints

Wir wissen heute, dass es eine Reihe geschlechtsspezifischer Unterschiede hinsichtlich Entstehung, Klinik, Verlauf und Prognose der koronaren Herzkrankheit (KHK) gibt [2]. Bei Frauen entwickelt sich die KHK circa 10 - 15 Jahre später als beim Mann, das Risiko steigt - vermutlich durch Wegfall der endogenen Steroidhormone - nach der Menopause an. Von besonderer Bedeutung ist die Tatsache, dass bei Frauen in der Regel zwar die gleichen Faktoren wie bei Männern atherogen wirken, diese aber in ihrer Wertigkeit zum Teil stark differieren: So ist bei Frauen der Diabetes mellitus mit einem zwei- bis dreifach höheren koronaren Risiko als bei Männern assoziiert. Eine bessere Kenntnis der Unterschiede in der atherogenen Potenz der Risikofaktoren ist somit für eine optimale geschlechtsspezifische Prävention und Therapie entscheidend [51]. Hier sollen die frauenspezifischen Besonderheiten im koronaren Risikofaktorprofil aufgezeigt, analysiert und in ihrer Wertigkeit dargestellt werden.

Literatur

  • 1 Anderson K M, Castelli W P, Levy D. Cholesterol and mortality: 30 years of follow-up from the Framingham study.  JAMA. 1987;  257 2176-2180
    Search in Google Scholar
  • 2 Arbogast A, Sechtem U. Diagnose der Herzkrankheit bei Frauen.  Dtsch Med Wochenschr. 2003;  128 97-102
    Search in Google Scholar
  • 3 Bankier B, Littman A B. Psychiatric disorders and coronary heart disease in women - a still neglected topic: review of the literature from 1971 to 2000.  Psychother Psychosom. 2002;  71 133-140
    Search in Google Scholar
  • 4 Castelli W P. Epidemiology of triglycerides: a view from Framingham.  Am J Cardiol. 1992;  70 3H-9H
    Search in Google Scholar
  • 5 Christen W G, Ajani U A, Glynn R J, Hennekens C H. Blood levels of homocysteine and increased risk of cardiovascular disease: causal or casual.  Arch Intern Med. 2000;  160 422-434
    Search in Google Scholar
  • 6 Corti M C, Guralnik J M, Salive M E. et al . HDL cholesterol predicts coronary heart disease mortality in older persons.  JAMA. 1995;  274 539-544
    Search in Google Scholar
  • 7 Dierkes J, Jeckel A, Ambrosch A, Westphal S, Luley C, Boeing H. Factors explaining the difference of total homocyst(e)ine between men and women in the European Investigation into Cancer and Nutrition Potsdam Study.  Metabolism. 2001;  50 640-645
    Search in Google Scholar
  • 8 Dorn J M, Schisterman E F, Winkelstein W, Trevisan M. Body mass index and mortality in a general population sample of men and women. The Buffalo Health Study.  Am J Epidemiol. 1997;  146 919-931
    Search in Google Scholar
  • 9 Eaker E D. Psychosocial risk factors for coronary heart disease in women.  Cardiol Clin. 1998;  16 103-111
    Search in Google Scholar
  • 10 Eriksson M, Egberg N, Wamala S, Orth-Gomer K, Mittleman M A, Schenck-Gustafsson K. Relationship between plasma fibrinogen and coronary heart disease in women.  Arterioscler Thromb Vasc Biol. 1999;  19 67-72
    Search in Google Scholar
  • 11 Folsom A R, Kushi L H, Anderson K E. et al . Association of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women’s Health Study.  Arch Intern Med. 2000;  160 2117-2128
    Search in Google Scholar
  • 12 Folsom A R, Nieto F J, McGovern P G. et al . Prospective study of coronary heart disease incidence in relation to fasting total homocysteine, related genetic polymorphisms, and B vitamines: the Atherosclerosis Risk in Communities (ARIC) study.  Circulation. 1998;  98 204-210
    Search in Google Scholar
  • 13 Folsom A R, Wu K K, Rasmussen M, Chambless L E, Aleksic N, Nieto F J. Determinants of population changes in fibrinogen and factor VII over 6 years. The Atherosclerosis Risk in Communities (ARIC) Study.  Arterioscler Thromb Vasc Biol. 2000;  20 601-606
    Search in Google Scholar
  • 14 Folsom A R, Wu K K, Rosamond W D, Sharrett A R, Chambless L E. Prospective study of hemostatic factors and incidence of coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study.  Circulation. 1997;  96 1102-1108
    Search in Google Scholar
  • 15 Friedlander Y, Arbogast P, Schwartz S M. et al . Family history as a risk factor for early onset myocardial infarction in young women.  Atherosclerosis. 2001;  156 201-207
    Search in Google Scholar
  • 16 Garber A M, Browner W S, Hulley S B. Cholesterol screening in asymptomatic adults, revisited.  Ann Intern Med. 1996;  124 518-531
    Search in Google Scholar
  • 17 Gohlke-Bärwolf C. Coronary artery disease - is menopause a risk factor?.  Basic Res Cardiol. 2000;  95 I/77-I/83
    Search in Google Scholar
  • 18 Gordon D J, Probstfield J L, Garrison R J. et al . High-density lipoprotein cholesterol and cardiovascular disease: four prospective American studies.  Circulation. 1989;  79 8-15
    Search in Google Scholar
  • 19 Grady D, Herrington D, Bittner V. et al. HERS Research Group . Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II).  JAMA. 2002;  288 49-57
    Search in Google Scholar
  • 20 Hahmann H W, Schätzer-Klotz D, Bunte T, Becker D, Schieffer H J. The significance of high levels of lipoprotein (a) compared with established risk factors in premature coronary artery disease: differences between men and women.  Atherosclerosis. 1999;  144 221-228
    Search in Google Scholar
  • 21 Haynes S G, Feinleib M, Kannel W B. The relationship of psychosocial factors to coronary heart disease in the Framingham Study. III. Eight-year incidence of coronary heart disease.  Am J Epidemiol. 1980;  111 37-58
    Search in Google Scholar
  • 22 Hokanson J E, Austin M A. Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies.  J Cardiovasc Risk. 1996;  3 213-219
    Search in Google Scholar
  • 23 Hu F B, Stampfer M J, Manson J E. et al . Trends in the incidence of coronary heart disease and changes in diet and lifestyle in women.  N Engl J Med. 2000;  343 530-537
    Search in Google Scholar
  • 24 Hu F B, Stampfer M J, Solomon C. et al . Physical activity and risk for cardiovascular events in diabetic women.  Ann Intern Med. 2001;  134 96-105
    Search in Google Scholar
  • 25 Kannel W B. Risk stratification in hypertension: new insights from the Framingham Study.  Am J Hypertens. 2000;  13 3S-10S
    Search in Google Scholar
  • 26 Kuulasmaa K, Tunstall-Pedoe H, Dobson A. et al., for the MONICA Project . Estimation of contribution of changes in classic risk factors to trends in coronary event-rates across the WHO MONICA Project populations.  Lancet. 2000;  355 675-687
    Search in Google Scholar
  • 27 Laakso M, Ronnemaa T, Lehto S, Puukka P, Kallio V, Pyorala K. Does NIDDM increase the risk for coronary heart disease similarly in both low- and high-risk populations?.  Diabetologia. 1995;  38 487-493
    Search in Google Scholar
  • 28 Laing S P, Swerdlow A J, Slater S D. et al . The British Diabetic Association Cohort Study, II: cause-specific mortality in patients with insulin-treated diabetes mellitus.  Diabet Med. 1999;  16 466-471
    Search in Google Scholar
  • 29 Lapidus L, Bengtsson C, Lindquist O, Sigurdsson J A, Ryboe E. Triglycerides - main lipid risk factor for cardiovascular disease in women?.  Acta Med Scand. 1985;  217 481-489
    Search in Google Scholar
  • 30 Lee I M, Rexrode K M, Cook N R, Manson J E, Buring J E. Physical activity and coronary heart disease in women: Is „no pain, no gain“ passé?.  JAMA. 2001;  285 1447-1454
    Search in Google Scholar
  • 31 Lee W L, Cheung A M, Cape D, Zinman B. Impact of diabetes on coronary artery disease in women and men: a meta-analysis of prospective studies.  Diabetes Care. 2000;  23 962-968
    Search in Google Scholar
  • 32 Manolio T A, Pearson T A, Wenger N K, Barrett-Connor E, Payne G H, Harlan W R. Cholesterol and heart disease in older persons and women: review of an NHLBI workshop.  Ann Epidemiol. 1992;  2 161-176
    Search in Google Scholar
  • 33 Mansfield M W, Heywood D M, Grant P J. Sex differences in coagulation and fibrinolysis in white subjects with non-insulin-dependent diabetes mellitus.  Arterioscler Thromb Vasc Res. 1996;  16 160-164
    Search in Google Scholar
  • 34 Manson J AE, Hu F B, Rich-Edwards J W. et al . A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women.  N Engl J Med. 1999;  341 650-658
    Search in Google Scholar
  • 35 Maron D J. The epidemiology of low levels of high-density lipoprotein cholesterol in patients with and without coronary artery disease.  Am J Cardiol. 2000;  86 11L-14L
    Search in Google Scholar
  • 36 Meade T W, Ruddock V, Stirling Y, Chakrabarti R, Miller G J. Fibrinolytic activity, clotting factors, and long-term incidence of ischaemic heart disease in the Northwick Park Heart Study.  Lancet. 1993;  342 1076-1079
    Search in Google Scholar
  • 37 Nanchahal K, Ashton W D, Wood D A. Association between blood pressure, the treatment of hypertension, and cardiovascular risk factors in women.  J Hypertens. 2000;  18 833-841
    Search in Google Scholar
  • 38 Orth-Gomer K, Horsten M, Wamala S P. et al . Social relations and extent and severity of coronary artery disease: The Stockholm Female Coronary Risk Study.  Eur Heart J. 1998;  19 1648-1656
    Search in Google Scholar
  • 39 Orth-Gomer K, Mittleman M A, Schenck-Gustafsson K. et al . Lipoprotein (a) as a determinant of coronary heart disease in young women.  Circulation. 1997;  95 329-334
    Search in Google Scholar
  • 40 Orth-Gomer K, Wamala S P, Horsten M, Schenck-Gustafsson K, Schneiderman N, Mittleman M A. Marital stress worsens prognosis in women with coronary heart disease: The Stockholm Female Coronary Risk Study.  JAMA. 2000;  284 3008-3014
    Search in Google Scholar
  • 41 Ossei-Gerning N, Wilson I J, Grant P J. Sex differences in coagulation and fibrinolysis in subjects with coronary artery disease.  Thromb Haemost. 1998;  79 736-740
    Search in Google Scholar
  • 42 Poulter R. for the WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception . Acute myocardial infarction and combined oral contraceptives: results of an international multicentre case-control study.  Lancet. 1997;  349 1202-1209
    Search in Google Scholar
  • 43 Ridker P M, Buring J E, Shih H, Matias M, Hennekens C H. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women.  Circulation. 1998;  98 731-733
    Search in Google Scholar
  • 44 Ridker P M, Hennekens C H, Buring J E, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women.  N Engl J Med. 2000;  342 836-843
    Search in Google Scholar
  • 45 Ridker P M, Manson J E, Buring J E, Shih J, Matias M, Hennekens C H. Homocyst(e)ine and risk of cardiovascular disease among postmenopausal women.  JAMA. 1999;  281 1817-1821
    Search in Google Scholar
  • 46 Rossouw J E, Anderson G L, Prentice R L. et al. Writing Group for the Women’s Health Initiative Investigators . Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial.  JAMA. 2002;  288 321-333
    Search in Google Scholar
  • 47 Rozanski A, Blumenthal J A, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implication for therapy.  Circulation. 1999;  99 2192-2217
    Search in Google Scholar
  • 48 Schulte H, von Eckardstein A, Cullen P, Assmann G. Obesity and cardiovascular risk.  Herz. 2001;  26 170-177
    Search in Google Scholar
  • 49 Sesso H D, Lee I M, Gaziano J M, Rexrode K M, Glynn R J, Buring J E. Maternal and paternal history of myocardial infarction and risk of cardiovascular disease in men and women.  Circulation. 2001;  104 393-398
    Search in Google Scholar
  • 50 Stampfer M J, Hu F B, Manson J E, Rimm E B, Willett W C. Primary prevention of coronary heart disease in women through diet and lifestyle.  N Engl J Med. 2000;  343 16-22
    Search in Google Scholar
  • 51 Stangl V, Baumann G, Stangl K. Coronary atherogenic risk factors in women.  Eur Heart J. 2002;  23 1738-1752
    Search in Google Scholar
  • 52 The writing group for the PEPI Trial . Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial.  JAMA. 1995;  273 199-208
    Search in Google Scholar
  • 53 Verhoef P. Hyperhomocysteinemia and risk of vascular disease in women.  Semin Thromb Hemost. 2000;  26 325-334
    Search in Google Scholar
  • 54 Wagenknecht L E, Craven T E, Preisser J S, Manolio T A, Winders S, Hulley S B. Ten-year trends in cigarette smoking among young adults, 1986 - 1996: The CARDIA Study.  Ann Epidemiol. 1998;  8 301-307
    Search in Google Scholar
  • 55 Wamala S P, Mittleman M A, Horsten M, Schenck-Gustafsson K, Orth-Gomer K. Job stress and the occupational gradient in coronary heart disease in women: The Stockholm Female Coronary Risk Study.  Soc Sci Med. 2000;  51 481-489
    Search in Google Scholar
  • 56 Welch G N, Loscalzo J. Homocysteine and atherothrombosis.  N Engl J Med. 1998;  338 1042-1050
    Search in Google Scholar
  • 57 Welty F K. Cardiovascular disease and dsylipidemia in women.  Arch Intern Med. 2001;  161 514-522
    Search in Google Scholar
  • 58 Willett W C, Manson J E, Stampfer M J. et al . Weight, weight change, and coronary heart disease in women.  JAMA. 1995;  273 461-465
    Search in Google Scholar
  • 59 Woodward M, Lowe G DO, Rumley A, Tunstall-Pedoe H. Fibrinogen as a risk factor for coronary heart disease and mortality in middle-aged men and women.  Eur Heart J. 1998;  19 55-62
    Search in Google Scholar

Priv.-Doz. Dr. med. Verena Stangl

Charité der Humboldt-Universität. Campus Mitte, Med. Klinik mit Schwerpunkt Kardiologie, Angiologie, Pneumologie

Schumannstraße 21/21

10117 Berlin

Phone: +49/030/450513153

Fax: +49/030/450513932

Email: verena.stangl@charite.de