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Mechanisms of action for estrogen in cardioprotection
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
Cardiovascular disease, and in particular cardiac ischemia, is the leading cause of morbidity and mortality in women1. Estrogen deficiency after the menopause is the single most important risk factor for cardiovascular disease in women2. Estrogen replacement therapy to postmenopausal women, on the other hand, significantly decreases the relative risks of cardiovascular disease and coronary artery heart disease, suggesting that estrogens directly affect the heart and confer a certain degree of protection3. Recent epidemiological studies have supported this hypothesis, and as a result, research has been focused on cellular and molecular mechanisms related to estrogen action on target organs including the heart and its vasculature. The objective of this review is to outline the existing data, and to emphasize their importance for the understanding of cardiac function vis-a-vis estrogen deficiency, and the role of estrogen replacement in cardio-protection.
Combined contribution
Published in Olaf Dammann, Etiological Explanations, 2020
Consider the following situation. In a large randomized trial including almost 40,000 healthy women, 45 years or older, designed to test the hypothesis that low-dose aspirin prevents cardiovascular disease in women, a prominent statistically significant protective effect of aspirin on major cardiovascular events (risk reduction by 26%) was identified in women 65 years or older, while no effect was observed among women 64 years or younger (Ridker et al. 2005). This is an example of effect modification by age: an effect is observed in one age group but not in another. Obviously, such results have direct implications for interventionalists. While it may seem best to prescribe aspirin to women 65 or older, but not to younger women, potential risks must be weighed against the benefits. In this case, in the age group 65 years or older, 44 fewer myocardial infarctions or deaths were seen, but aspirin use came with 16 more cases of gastrointestinal hemorrhage.
Surface Guidance for Breast
Published in Jeremy D. P. Hoisak, Adam B. Paxton, Benjamin Waghorn, Todd Pawlicki, Surface Guided Radiation Therapy, 2020
The risk of radiation therapy-associated cardiovascular disease in women with breast cancer has been a concern for decades.1,2 One approach to reduce incidental cardiac irradiation is to treat patients specifically during a deep inspiration breath hold (DIBH) maneuver, where for most patients, a deep inspiration displaces the heart medially, inferiorly, and posteriorly (i.e., away from the left breast and chest wall; Figure 10.1). Using a variety of methods, the clinician can monitor the patient’s respiration, instruct them to take in a deep breath, and when the patient achieves the required level of deep inspiration, the breath is then held for as long as possible while the radiation dose is delivered. This approach allows a treatment plan to maintain coverage of the target tissues while markedly reducing the degree of incidental cardiac irradiation.3,4
Gender differences in cardiovascular risk, treatment, and outcomes: a post hoc analysis from the REWIND trial
Published in Scandinavian Cardiovascular Journal, 2023
Giulia Ferrannini, Juan M. Maldonado, Sohini Raha, Purnima Rao-Melacini, Rutaba Khatun, Charles Atisso, Linda Shurzinske, Hertzel C. Gerstein, Lars Rydén, M. Angelyn Bethel
Despite improvements in diagnosis and management, cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in people with diabetes [1,2]. Although the results are conflicting, some meta-analyses report that diabetes is associated with greater relative risk of fatal coronary heart disease, stroke or cardiovascular death in women compared with men [2–6]. The traditional view that men are at a higher risk for cardiovascular disease than women may account for this difference. It may also result in the use of fewer cardioprotective therapies in women, including lipid-lowering and antiplatelet drugs [2,7]. Possible reasons for this gender disparity are unclear, growing evidence suggests that type 2 diabetes adversely affects metabolic and cardiovascular risk factor profiles to a greater extent in women than men. For example, women with diabetes are more likely to have obesity, hypercholesterolemia, hypertension [2], and a more rapid rise in blood pressure levels than men [8]. Moreover, vascular disease is expressed differently, with men more likely to develop occlusive coronary artery disease, and women more likely to develop nonobstructive coronary artery disease or microvascular dysfunction [9].
Contribution of environmental factors and female reproductive history to hypertension and obesity incidence in later life
Published in Annals of Human Biology, 2022
Lenka Vorobeľová, Darina Falbová, Veronika Candráková Čerňanová
Despite the environmental factors, there is accumulating evidence regarding the importance of understanding cardiovascular disease outcomes related to female reproductive factors (Pandeya et al. 2018; Okoth et al. 2020). Although recent studies have emphasised the role of reproductive history in evaluating cardiovascular disease in women, less is known regarding their determinants, such as hypertension and obesity (Liu et al. 2021). This is despite the fact that childbirth is positively associated with obesity in postmenopausal women and with hypertension in premenopausal women from Japan (Ohashi et al. 2022), and that breastfeeding could have long-term effects on mothers’ risk of developing cardiovascular disease risk factors such as hypertension and abdominal obesity (Peters et al. 2017; Kirkegaard et al. 2018; Cieśla et al. 2021).
Genistein for glycolipid metabolism in postmenopausal women: a meta-analysis
Published in Climacteric, 2021
Menopause refers to the failure of ovarian function in women, accompanied by a reduction in estrogen levels. Loss of estrogen may lead to unfavorable changes in lipid profiles and glycemic metabolism, including elevated low-density lipoprotein cholesterol (LDL-C), reduced high-density lipoprotein cholesterol (HDL-C), hypertriglyceridemia, and impaired glucose tolerance, which could increase the risk for cardiovascular disease and diabetes in postmenopausal women1–3. Hormone replacement therapy (HRT) is effective for relieving clinical menopausal symptoms such as hot flushes and mood changes, but research found that HRT could increase risk for breast, endometrial, and ovarian cancer, thromboembolism, and ischemic stroke4–6. The Women’s Health Initiative (WHI) study showed that HRT did not provide cardiac protection and might increase the risk of coronary heart disease among healthy postmenopausal women, and was not suggested for the primary prevention of cardiovascular disease in postmenopausal women7. Based on the results of the Heart and Estrogen/progestin Replacement Study (HERS), HRT failed to reduce the overall rate of cardiovascular disease in women with established cardiovascular disease, and was also not suggested in the secondary prevention of coronary heart disease8. Therefore, more alternative approaches for improving glycolipid metabolism and avoiding adverse effects of HRT in postmenopausal women are required.