Lee JJ, et al. - Using data from the original WISE (Women's Ischemia Syndrome Evaluation) prospective cohort, researchers assessed age at menarche in relation to the role of estrogen over a lifetime and major adverse cardiac events (MACE). At baseline, 648 women without surgical menopause undergoing coronary angiography for suspected ischemia were examined. In these subjects, major adverse cardiovascular disease (CVD) outcomes were assessed during 6 years (median) of follow-up. A relatively higher risk of MACE and all-cause mortality was observed among women with early or later menarche. Earlier recognized CVD risk factors or estrogen exposure or supra–physiologic states of estrogen exposure did not explain these links. A link between inflammatory biomarkers, such as serum amyloid A, and angiographic coronary artery disease was shown, and therefore, a possible role of these in mediating atherosclerotic plaque destabilization was suggested.