Monday, March 07, 2011


The saying is true, that pre-menopausal females are protected from CAD, and when they reach menopause, the oestrogen/progestrogen balance is reversed, and they will then run the same risk of CAD as an adult male above 40years.
There is a recent paper that seem to focus the risk a bit more. Dr Emily Szmuilowicz at el, writing in the journal, Menopause, Feb 19th 2011 issue, described a study that they carried out under the " Women's Health Initiative Observational Study. It is an observational study. They observed 60,025 post menopausal women, and found that those women who experienced hot flushes early, early in their menopause, seemed to have a lower incidence of CAD then those who do not. Interestingly, those who experience hot flushes, late ( average 14 years ) after menopause, seem to have an increase risk of CAD. Mechanistically, that would be difficult to explain. Hot flushes are due to vasomotor response, meaning that it is healthy vaso-dilatation, which must mean a healthy circulation. So females who have health vasomotor reaction, early in their menopasue have a healthy circulation, though they are in menopause, but why does the same vasomotor response mean an increase CAD risk, later in menopause? Is it the same vasomotor response? That is where we do not know.
I though that it was interesting. We need to understand females with CAD better, as they are often slightly different in their presentation and also their outcome. Their vessels are smaller and often are more reactive.
I suppose we should still bank on the traditional risk factors to understand causation of CAD, until we can know the cause ( if any )? Cigarette smoking, hypertension, diabetes, dyslipidemia, obesity, lack of exercise, family history and risk factors like that are still more important then hot flushes, interesting though this may be. Perhaps one day , we will have a good explanation for the hot flushes. Until then it remains an interesting observation by the workers from North-Western University, Chicago.

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