title: Hypertension, menopause, and coronary artery disease risk in the Women's Ischemia Syndrome Evaluation (WISE) Study.
abstract: OBJECTIVE
  We evaluated whether the relationship between hypertension, other cardiac risk factors, and coronary artery disease (CAD) is modulated by menopausal status and/or age.
  
  
  BACKGROUND
  The relative contribution of age versus menopausal status in the development of CAD in women remains unclear.
  
  
  METHODS
  We compared systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and traditional cardiac risk factors for CAD in premenopausal (n = 123) and postmenopausal (n = 482) women undergoing coronary angiography for suspected ischemia. To assess the relative contribution of age versus menopausal status, we fit a hypertension-menopausal status interaction term and adjusted for age.
  
  
  RESULTS
  There were similar relationships with regard to traditional coronary risk factors and angiographic CAD in premenopausal versus postmenopausal women, with few exceptions. Twenty percent of premenopausal women had angiographic CAD versus 31% of postmenopausal women (p = 0.02). Premenopausal women had lower mean (standard deviation) SBP (132 [25] vs. 139 [20] mm Hg; p < 0.0001) and lower PP (54 [18] vs. 62 [18] mm Hg; p < 0.0001) compared to postmenopausal women; however, multivariable analyses revealed that SBP was a risk factor for CAD in premenopausal (p = 0.002) but not postmenopausal women (p = 0.13), and regression slopes were significantly different (p = 0.04). This interaction effect remained after age adjustment, suggesting independent risk contribution from both age and menopausal status. A similar slope difference was observed for PP (p = 0.03) but not for DBP.
  
  
  CONCLUSIONS
  Among women undergoing angiography for suspected ischemia, elevated SBP and PP are potent risk factors in premenopausal women. The results suggest that identification of hypertension in premenopausal women dictates additional CAD risk factor assessment and management.
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
authors.forename: Gretchen L
authors.initials: GL
authors.lastname: Gierach
authors.forename: B Delia
authors.initials: BD
authors.lastname: Johnson
authors.forename: C Noel
authors.initials: CN
authors.lastname: Bairey Merz
authors.forename: Sheryl F
authors.initials: SF
authors.lastname: Kelsey
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.forename: Marian B
authors.initials: MB
authors.lastname: Olson
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: Sunil
authors.initials: S
authors.lastname: Mankad
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.forename: Steven E
authors.initials: SE
authors.lastname: Reis
authors.forename: William J
authors.initials: WJ
authors.lastname: Rogers
authors.forename: Barry L
authors.initials: BL
authors.lastname: Sharaf
authors.forename: George
authors.initials: G
authors.lastname: Sopko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors