Coronary heart disease - protection by hormone preparations controversial

Women fall ill about 10 to 15 years later than men with coronary heart disease, a calcification of the coronary arteries, which can lead to heart attack. Before menopause, they are largely protected by the female sex hormones. After that, however, there is a sudden increase in the risk. A long considered plausible therapy, the intake of hormone preparations, has recently proved to be unsuitable.

Risk factors weigh heavier in women

Some of the risk factors now have a greater "atherogenic potency" in women than in men. That is, they lead to faster vascular calcification. The most obvious difference is the age-related sugar (type 2 diabetes). It is an important cause of CHD in both men and women. But in women, this risk factor is two to three times stronger than in men.

At the same laboratory values, lipid metabolism disorders also endanger women more than men: women with high triglyceride levels become twice as likely as men to have CHD. HDL cholesterol also penalizes women. A lack of this "good cholesterol" leads to CHD rather than to men. It is also easier for women to pass on the system to CHD: if the mother had a heart attack, the daughter's cardiovascular risk is 46 percent higher. If the own father fell ill, the risk increases only by 15 per cent.

Reasons are still in the dark

The reasons for these gender differences are still largely unknown. An important role is probably played by the hormonal changes after the menopause. But a long considered plausible therapy, the intake of hormone preparations, has recently proven to be unsuitable to protect women from CHD. According to recent studies, the hormone preparations even lead to a further increase in risk.

Possible cause: The hormones that protect against CHD before menopause stimulate the inflammatory reaction in the blood vessels at the onset of CHD in old age. This is indicated by an increase of the C-reactive protein in the blood, which occurs when the hormone is given.

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