ABSTRACT
The prevalence of cardiovascular disease (CVD) among women and men, and its position as the leading cause of death, underscores the need for a comprehensive risk factor profile to direct prevention efforts. The knowledge of the female risk profile is unsatisfactory, largely because most research on risk factors and prediction of CVD has been conducted in men.1,2 What is known about traditional risk factors in women is based on such population-based longitudinal studies as the Framingham Study, the Gothenburg Study, and the MONICA study.3-5 The Framingham Study, for example, generated a risk equation for women that includes age, systolic blood pressure, cholesterol, high-density lipoprotein (HDL), glucose intolerance, cigarette smoking, and electrocardiogram (ECG) evidence of myocardial hypertrophy. The Framingham women who were aged between 60 and 64 years and at highest risk, i.e. in the upper 10% of the risk factor distribution, had a 12% probability of developing coronary heart disease (CHD) during a 6-year follow-up; the comparable probability for men was 20%.6 These small probabilities indicate the lack of specificity in the prediction of CHD risk, in particular for women but also for men. It is also evident that the traditional risk factors incorporated in the equations explain only a portion of the risk, and that other risk factors must contribute as well. These less well-established factors include social, psychological, and behavioral variables, the role of which has been less extensively studied in women than in men.7 The purpose of this chapter is to highlight the relative importance of psychosocial, as compared with traditional factors, in understanding CVD among women.
