Mechanisms of action for estrogen in cardioprotection
Barry G. Wren in 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.
Cardiovascular Disease
Deborah Fish Ragin in Health Psychology, 2017
One reason for the higher incidences of heart disease in women after age 50 appears to be physiological. On average, until age 45, women’s bodies produce high levels of estrogen, a vital hormone for reproduction. Research suggests that estrogen plays two essential roles in women’s health. It is crucial for reproduction, but it is also a protective factor that helps minimize the risk of cardiovascular disease for women who are premenopausal, that is, women who are still potentially reproductively active. In fact, some research suggests that estrogen also helps to lower the LDL cholesterol level in the blood (Lee & Foody, 2008; Kalin & Zumoff, 1990). Between the ages of 45 and 55, however, estrogen levels decrease substantially. It is during this time that rates of heart disease show marked increases that continue in the succeeding years.
Surface Guidance for Breast
Jeremy D. P. Hoisak, Adam B. Paxton, Benjamin Waghorn, Todd Pawlicki in 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].
Beyond JNC 8: implications for evaluation and management of hypertension in underserved populations
Published in Acta Cardiologica, 2019
Joseph Burns, Dharam Persaud-Sharma, Dollie Green
Risk of cardiovascular disease in women is uniformly underestimated by predictive models. This poor prediction is influenced by multiple factors that influence heart disease in American women. Financial disparities perpetuate a system of health inequity in which poor women seek care less and receive inferior treatment. In the United States, women earn approximately 80% of a similarly employed man, which also manifests through lower Social Security payments [12]. Throughout life, American women are placed at an economic disadvantage which results in limited patterns of healthcare access and use. Minority women, particularly African-Americans and Native Americans have worse health outcomes due to cardiovascular disease [12]. In addition to environmental factors, in African-American women, polymorphisms in epithelial sodium channels are associated with patterns of hypertension [13].
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).
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- Women'S Health
- Cardiovascular Disease
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- Coronary Artery Disease
- Stroke
- Cardiomyopathy
- Myocardial Infarction
- Aortic Aneurysm
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