Risk factors for women & heart disease

Executive Summary

* A study was published in JAMA Cardiology on January 20th, 2021.

* The study included 28,000 women from the US Women's Health Study, who were followed-up for 21 years. The goal was to examine the first diagnosis of Coronary Heart Disease (CHD) and to see which risk factors this was most associated with.

* The study reviewed women in four age groups – under the age of 55; 55 to under 65; 65 to under 75 and 75 or older.

* Reassuringly, 94.5% of women did not develop heart disease during 600,000 person years of follow-up.

* Having diabetes at the start of the study was the single biggest risk factor for developing CHD in any age group and especially when younger. Women with diabetes were nearly 11 times more likely to develop heart disease before the age of 55 than women without diabetes.

* Metabolic syndrome was the second highest risk factor – dwarfing even smoking. Blood lipid measures (cholesterol) were inconsequential in comparison with blood glucose measures.

* A 1997 Scottish paper undertook a similar exercise by ranking risk factors for all-cause mortality in men and women separately. This also found that there were far greater risk factors than cholesterol and yet cholesterol (different measures thereof) has been the major focus for heart disease in the almost 25 years between these two papers.

* This metabolic vs lipid finding should be a game changer, but it probably won't be.

Introduction

Many thanks to Dr Eric Westman for this week’s topic. Eric sent me a paper which was published in JAMA Cardiology on January 20th, 2021. It was called "Association of lipid, inflammatory, and metabolic biomarkers with age at onset for incident Coronary Heart Disease in women" (Ref 1). The goal was to examine first incidence of heart disease in women and to see which baseline characteristics of those women were associated with heart disease. Women were examined in four groups, providing an age-dimension to the study. The age groups were under the age of 55; 55 to under 65; 65 to under 75 and 75 or older.