***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Importance It is not clear to what extent the higher incidence of coronary heart disease ( CHD ) in men vs women is explained by differences in risk factor levels because few studies have presented adjusted risk estimates for sex . Moreover , the increase in risk of CHD in postmenopausal women , possibly hormone related , may eventually eliminate the sex contrast in risk , but age-specific risk estimates are scarce . Objective To quantify the difference in risk of incident myocardial infa rct ion ( MI ) between men and women . Design , Setting and Participants Population -based prospect i ve study from Tromsø , Norway , comprising 33 997 individuals ( 51 % women ) . Median follow-up time during ages 35 to 102 years was 17.6 years . Incidence rates ( IRs ) and incidence rate ratios ( IRRs , relative risk ) of MI were calculated in Poisson regression analysis of person-years at risk . The data analysis was performed in November 2015 . Exposures Sex , age , birth cohort , serum lipid levels , blood pressure , lifestyle factors , diabetes . Main Outcomes and Measures Incident MI . Results A total of 2793 individuals ( 886 women ) received a diagnosis of MI during follow-up in the period 1979 through 2012 . The IR increased with age in both sexes , with lower rates for women until age 95 years . Adjusted for age and birth cohort , the overall IRR for men vs women was 2.72 ( 95 % CI , 2.50 - 2.96 ) . Adjustment for high-density lipoprotein cholesterol and total cholesterol levels had the strongest impact on the risk estimate for sex , followed by diastolic blood pressure and smoking . However , the sex difference remained substantial even after adjustment for these factors ( IRR , 2.07 ; 95 % CI , 1.89 - 2.26 ) . Men had higher risk throughout life , but the IRRs decreased with age ( 3.64 [ 95 % CI , 2.85 - 4.65 ] , 2.00 [ 95 % CI , 1.76 - 2.28 ] , and 1.66 [ 95 % CI , 1.42 - 1.95 ] for age groups 35 - 54 , 55 - 74 , and 75 - 94 years , respectively ) . Adjustment for systolic blood pressure , diabetes , body mass index , and physical activity had no notable impact . Conclusions and Relevance The observed sex contrast in risk of MI can not be explained by differences in established CHD risk factors . The gender gap persisted throughout life but declined with age as a result of a more pronounced flattening of risk level changes in middle-aged men . The minor changes in IRs when moving from premenopausal to postmenopausal age in women make it unlikely that changes in female hormone levels influence the risk of MI Background and Purpose The purpose of the present analysis was to determine how lifestyle influences the risk of cerebrovascular disease in women participating in the Copenhagen City Heart Study . Methods A r and om sample of a white , lower and middle-class , urban population selected in 1976 was invited to two cardiovascular examinations at 5-year intervals . The present analysis was based on 7060 women invited to an initial examination from 1976 through 1978 , aged 35 years or more , and without previous stroke or transient ischemic attack . At the initial examination , potential risk factors were recorded . The 265 first cases of stroke and transient ischemic attack were ascertained at a second examination 5 years later and through hospital records and death certificates through 1988 . The Cox regression model was used to estimate the influence of the factors recorded on the risk of cerebrovascular disease . Results The relative risks of cigarette smoking and lack of physical activity were 1.4 and 1.45 ; 95 % confidence limits , 1.02 to 1.94 and 1.01 to 2.08 , respectively ) . The relative risk of daily consumption of tranquilizers  was 1.25 ( 95 % confidence limits , 0.96 to 1.62 ) . No significant influence was found for number of cigarettes , body mass index , or alcohol intake . In postmenopausal women , there was a statistically significant interaction ( P < .041 ) between smoking and hormone replacement therapy .  Smokers receiving this therapy had a 28 % lower risk of cerebrovascular disease than smokers not receiving it . Conclusions The statistically significant and equally potent effects on the risk of cerebrovascular disease were found for cigarette smoking and lack of physical activity . The risk associated with smoking seemed to be influenced by hormonal replacement therapy Objective To evaluate the impact of combinations of lifestyle factors on  mortality in middle aged women . Design Prospect i ve cohort study . Setting Nurses ’ health study , United States . Participants 77 782 women aged 34 to 59 years and free from cardiovascular disease and cancer in 1980 . Main outcome measure Relative risk of mortality during 24 years of follow-up in relation to five lifestyle factors ( cigarette smoking , being overweight , taking little moderate to vigorous physical activity , no light to moderate alcohol intake , and low diet quality score ) . Results 8882 deaths were documented , including 1790 from cardiovascular disease and 4527 from cancer . Each lifestyle factor independently and significantly predicted mortality . Relative risks for five compared with zero lifestyle risk factors were 3.26 ( 95 % confidence interval 2.45 to 4.34 ) for cancer mortality , 8.17 ( 4.96 to 13.47 ) for cardiovascular mortality , and 4.31 ( 3.51 to 5.31 ) for all cause mortality . A total of 28 % ( 25 % to 31 % ) of deaths during follow-up could be attributed to smoking and 55 % ( 47 % to 62 % ) to the combination of smoking , being overweight , lack of physical activity , and a low diet quality . Additionally considering alcohol intake did not substantially change this estimate . Conclusions These results indicate that adherence to lifestyle guidelines is associated with markedly lower  mortality in middle aged women . Both efforts to eradicate cigarette smoking and those to stimulate regular physical activity and a healthy diet should be intensified BACKGROUND Moderate alcohol consumption is inversely associated with cardiovascular diseases . Changes in hormone levels might in part help explain the positive health effect . This study was performed to examine the effect of moderate alcohol consumption on plasma dehydroepi and rosterone sulfate ( DHEAS ) , testosterone , and estradiol levels . METHODS In a r and omized , diet-controlled , crossover study , 10 middle-aged men and 9 postmenopausal women , all apparently healthy , nonsmoking , and moderate alcohol drinkers , consumed beer or no-alcohol beer with dinner during two successive periods of 3 weeks . During the beer period , alcohol intake equaled 40 and 30 g per day for men and women , respectively . The total diet was supplied and had essentially the same composition during these 6 weeks . Before each treatment there was a 1 week washout period , in which the subjects were not allowed to drink alcoholic beverages . At the end of each of the two experimental periods , fasting blood sample s were collected in the morning . RESULTS Moderate alcohol consumption increased plasma DHEAS level by 16.5 % ( 95 % confidence interval , 8.0 - 24.9 ) , with similar changes for men and women . Plasma testosterone level decreased in men by 6.8 % ( 95 % confidence interval , -1.0- -12.5 ) , but no effect was found in women . Plasma estradiol level was not affected . Serum high-density lipoprotein cholesterol level increased by 11.7 % ( 95 % confidence interval , 7.3 - 16.0 ) , with similar changes for men and women . The overall alcohol-induced relative changes in DHEAS , testosterone , and estradiol correlated positively with the relative increase in high-density lipoprotein cholesterol ( adjusted for the relative change in body weight ) ; however , findings were only borderline significant for DHEAS and estradiol ( r = 0.44 , p = 0.08 ; r = 0.32 , p = 0.21 ; and r = 0.46 , p = 0.06 , respectively ) . CONCLUSIONS A protective effect of moderate alcohol consumption for cardiovascular disease risk may in part be explained by increased plasma DHEAS level CONTEXT Obesity is a well-established risk factor for coronary heart disease ( CHD ) , but whether regional fat distribution contributes independently to risk remains unclear . OBJECTIVE To compare waist-hip ratio ( WHR ) and waist circumference in determining risk of  CHD in women . DESIGN AND SETTING Prospect i ve cohort study among US female registered nurses participating in the Nurses ' Health Study conducted between 1986 , when the nurses completed a question naire , and follow-up in June 1994 . PARTICIPANTS A total of 44702 women aged 40 to 65 years who provided waist and hip circumferences and were free of prior CHD , stroke , or cancer in 1986 . MAIN OUTCOME MEASURES Incidence of CHD ( nonfatal myocardial infa rct ion or CHD death ) . RESULTS During 8 years of follow-up 320 CHD events ( 251 myocardial infa rct ions and 69 CHD deaths ) were documented . Higher WHR and greater waist circumference were independently associated with a significantly increased age-adjusted risk of CHD . After adjusting for body mass index ( BMI ) ( defined as weight in kilograms divided by the square of height in meters ) and other cardiac risk factors , women with a WHR of 0.88 or higher had a relative risk ( RR ) of 3.25 ( 95 % confidence interval [ CI ] , 1.78 - 5.95 ) for CHD compared with women with a WHR of less than 0.72 . A waist circumference of 96.5 cm ( 38 in ) or more was associated with an RR of 3.06 ( 95 % CI , 1.54 - 6.10 ) . The WHR and waist circumference were independently strongly associated with increased risk of CHD also among women with a BMI of 25 kg/m2 or less . After adjustment for reported hypertension , diabetes , and high cholesterol level , a WHR of 0.76 or higher or waist circumference of 76.2 cm ( 30 in ) or more was associated with more than a 2-fold higher risk of CHD . CONCLUSIONS The WHR and waist circumference are independently associated with risk of CHD in women OBJECTIVES The aim of our study was to determine the effect of the menopause on various coronary heart disease ( CHD ) risk factors and on the global risk of CHD in a population based sample of women , making the difference between menopause and age related effects . STUDY DESIGN The Third French MONICA cross-sectional survey on cardiovascular risk included 1730 r and omly selected women , aged 35 - 64 years , representative from the general population . MAIN OUTCOME MEASURES Women were defined as post-menopausal ( postM ; n=696 ) , peri-menopausal ( periM ; n=183 ) or pre-menopausal ( preM ; n=659 ) based on the date of last menses . Socio-demographic , clinical and biological data were collected . Analyses of variance were used to compare means . RESULTS PostM women had significantly higher age-adjusted levels of total cholesterol ( 6.0mmol/L in postM vs. 5.7mmol/L in preM , p<0.05 ) and LDL cholesterol ( 3.9mmol/L vs. 3.6mmol/L , p<0.05 ) . There was no difference in HDL cholesterol or triglyceride levels , glycemia or blood pressure . Further adjustment on body mass index and hormonal treatments did not modify the results . No risk factor was significantly different between periM and postM. However , the Framingham 10-year risk of CHD was higher in postM , as compared with periM ( 5.1 % vs. 5.0 % , p<0.05 ) . In postM women , lipids and the Framingham risk were not associated with elapsed time since menopause . CONCLUSIONS The CHD risk increases during the sixth decade could be explained not only by estrogen deprivation but also by an effect on lipid profile , which is likely to occur in the peri-menopause period OBJECTIVES This prospect i ve study examined whether changes in traditional and novel coronary heart disease ( CHD ) risk factors are greater within a year of the final menstrual period ( FMP ) , relative to changes that occur before or after that interval , in a multiethnic cohort . BACKGROUND Underst and ing the influence of menopause on CHD risk remains elusive and has been evaluated primarily in Caucasian sample s. METHODS SWAN ( Study of Women 's Health Across the Nation ) is a prospect i ve study of the menopausal transition in 3,302 minority ( African American , Hispanic , Japanese , or Chinese ) and Caucasian women . After 10 annual examinations , 1,054 women had achieved an FMP not due to surgery and without hormone therapy use before FMP .  Measured CHD risk factors included lipids and lipoproteins , glucose , insulin , blood pressure , fibrinogen , and C-reactive protein . We assessed which 
    Output:
    
This meta- analysis suggests that physical activity and moderate alcohol intake were associated with a reduced risk for CVD and mortality .
Smoking and higher BMI were associated with an increased risk of these endpoints .
Adherence to a healthy lifestyle may substantially lower the burden of CVD and reduce the risk of mortality  among middle-aged and elderly women .