The initial interst in coronary- heart disease research in the 1950s centered
primarily on men because of its emergence as a major cause of morbidity
and mortality in men around middle age. In women, the incidence of coronary
heart disease is low at younger age and increases after middle age, though the
occurrence remains lower in women than in men at all ages. The fact that cardiovascular
disease is the major cause of morbidity and mortality in women has
been recognized already for many years and the last decade much effort has
been put in describing and studying cardiovascular disease in women. Despite
the research that has been carried out on the differences in cardiovascular disease
between the sexes, the gender gap in coronary- heart disease occurrence is
not completely understood until now. 1
The work presented in this thesis aims at gaining insight into gender specific
issues of cardiovascular disease and the cause of the rising incidence of cardiovascular
disease in women after middle age by studying putative endocrine and
metabolic risk factors. Data from various population-based studies were used to
study these issues.
In chapter 2, studies on classical cardiovascular disease risk factors attenuating
the female advantage with regard to cardiovascular disease occurrence
are presented. Chapter 3 contains studies on sex specific determinants of cardiovascular
disease with a focus on sex steroids. In chapter 4, studies on alternative
endocrine cardiovascular disease risk factors in postmenopausal women
are described. In chapter 5, the results described in this thesis are placed in a
broader context, some methodological considerations are discussed, and views
on further research regarding gender specific issues of cardiovascular disease
are put forward