There is considerable debate among scientists concerning whether the sex hormone oestrogen protects women from coronary heart disease (CHD). In most industrialised countries death rates from CHD are lower in women than men but this sex difference decreased with increasing age. Previous studies looking at changes in the death rate from CHD with age have shown that the decrease in the sex difference is the result of a deceleration in male rates, with no change in female rates around the age of the menopause. By contrast the age-specific rate of breast cancer—a condition for which there is strong evidence that oestrogen increases risk—does show a change around the age of menopause among US women. These findings have been used to suggest that oestrogen does not have an important role in protecting women from CHD. Others have said that the relatively low rates of CHD in pre-menopausal women may make it difficult to detect an effect of the menopause on this condition. We have looked at trends in death rates for CHD and breast cancer by age among UK adults and Japanese adults. The investigation among Japanese women is important because breast cancer is rare in Japan. If low rates of CHD around the time of the menopause explain the lack of an effect of the menopause on age related trends then one might expect no effect to be seen in breast cancer trends amongst Japanese women. CHD death rates in women from both countries increased with age and in both countries the male rate decelerated at older ages, reducing the magnitude of the sex difference. No inflection in female age-specific CHD mortality rates around the age of menopause in either England and Wales or Japan was found. By contrast, the age trends in breast cancer mortality rates began to decelerate around the time of the menopause in both groups. Breast cancer rates in women from Japan are about half those of CHD mortality in England and Wales at ages 45–54 (i.e. 12/100 000 vs. 20/100 000), thus it is unlikely that the low rates of CHD mortality make detection of a menopause effect difficult. The inflection in breast cancer rates occurs over a narrow age range suggesting that if menopausal oestrogen effects on CDH occurred, they too should operate over a similar range and be observable. We conclude that environmental factors are the most important determinants of CHD in women and men, and of the difference in CHD occurrence between women and men. There is a little evidence that oestrogen has an important protective effect in women.
|Translated title of the contribution||Oestrogen does not seem to be important in preventing heart disease in women|
|Pages (from-to)||109 - 111|
|Number of pages||3|
|Journal||Biomedicine & Pharmacotherapy|
|Publication status||Published - Mar 2003|