Coronary artery diseaseDiabetes Mellitus, Hypothalamic Hypoestrogenemia, and Coronary Artery Disease in Premenopausal Women (from the National Heart, Lung, and Blood Institute Sponsored WISE Study)
Section snippets
Methods
The WISE Study was a National Heart, Lung, and Blood Institute–sponsored cross-sectional, observational 4-center study that aimed to improve diagnostic testing and advance new hypotheses relative to the pathophysiologic process of ischemic heart disease in women. A total of 936 women undergoing clinically indicated coronary angiography for suspected ischemia were recruited into WISE. Our analysis was limited to 95 women of the entire cohort who were premenopausal, were not using hormone therapy
Results
Of 936 WISE study subjects, 515 were not currently using exogenous hormones, had no previous diagnosis of CAD, and had complete demographic and reproductive status data. Of these, 95 (18%) were premenopausal. Age ranged from 21 to 54 years; 23 (24%) were nonwhite, mostly African American; and mean body mass index was 31.2 ± 6.9 kg/m2, with a range of 17.7 to 52.2. Despite a high prevalence of coronary risk factors, only a minority (13%) of these premenopausal women had angiographic CAD. A total
Discussion
Our findings showed that DM was associated with HHE in premenopausal women undergoing coronary angiography for suspected myocardial ischemia. We also showed an increased prevalence and extent of angiographic coronary artery disease in women with DM and HHE compared with women without DM or with DM or HHE alone.
The exact mechanism by which DM ameliorates the female protection against coronary heart disease, especially in young premenopausal women, is not well understood. Endogenous estrogens
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This work was supported by Contracts N01-HV-68161, N01-HV-68162, N01-HV-68163, and N01-HV-68164 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland; GCRC Grant MO1-RR00425 from the National Center for Research Resources, Bethesda, Maryland; and grants from the Gustavus and Louis Pfeiffer Research Foundation, Denville, New Jersey; The Women's Guild of Cedars-Sinai Medical Center, Los Angeles, California; and The Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, Pennsylvania.