Extreme concentrations of endogenous sex hormones, ischemic heart disease, and death in women (original) (raw)
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Severity of cardiovascular disease in women: Relation with exposure to endogenous estrogen
Maturitas, 2006
Objectives: Coronary artery disease (CAD) is more common in men than in women. Endogenous sex steroids may be the main factor responsible, as long-term estrogen action appears to be protective. The aim of the study was to investigate the predisposing factors responsible for the severity of CAD in women. Methods: One hundred and eight women (100 menopausal) undergoing coronary angiography were studied. Reproductive function was recorded. The severity of CAD was assessed by the number of arteries with severe stenosis, the presence of angina and myocardial infarctions (MI). Results: The time since menopause (TSM) was significantly longer in women with angina and with MIs compared to those without (20.3 ± 8.7 years versus 15.8 ± 8.7 years and 22.6 ± 8.6 years versus 18.1 ± 8.9 years, p < 0.05), independently of chronological age. The age at menopause was significantly younger in women who had 2 MIs compared to those with 1 or 0 MI (41.5 ± 3.5, 47.5 ± 5.3 and 48.4 ± 5.4 years, respectively; p = 0.04); the total duration of menstrual cyclicity was inversely related to the number of MIs (35.6 ± 5.8, 34.2 ± 5.3 and 28.3 ± 3.3 years, 0, 1 and 2 MIs, respectively; p = 0.03). Conclusions: The severity of CAD in women referred for coronary angiography is correlated with measures of exposure to endogenous estrogen. Both the TSM and the age at menopause are aggravating factors for MI, independently of age. There is an independent protective effect of the duration of estrogen exposure on the number of MIs; this has not been reported before and supports the protective role of the length of exposure to endogenous estrogen, especially for the occurrence of MI in this selected group of women.
Endogenous Sex Hormones and Incident Cardiovascular Disease in Post-Menopausal Women
Journal of the American College of Cardiology, 2018
Higher androgen and lower estrogen levels are associated with cardiovascular disease (CVD) risk factors in women. However, studies on sex hormones and incident CVD events in women have yielded conflicting results. The authors assessed the associations of sex hormone levels with incident CVD, coronary heart disease (CHD), and heart failure (HF) events among women without CVD at baseline. The authors studied 2,834 post-menopausal women participating in the MESA (Multi-Ethnic Study of Atherosclerosis) with testosterone, estradiol, dehydroepiandrosterone, and sex hormone binding globulin (SHBG) levels measured at baseline (2000 to 2002). They used Cox hazard models to evaluate associations of sex hormones with each outcome, adjusting for demographics, CVD risk factors, and hormone therapy use. The mean age was 64.9 ± 8.9 years. During 12.1 years of follow-up, 283 CVD, 171 CHD, and 103 HF incident events occurred. In multivariable-adjusted models, the hazard ratio (95% confidence interva...
European Journal of Endocrinology, 2009
ObjectiveTo study the impact of endogenous testosterone levels in community-dwelling men on later risk for myocardial infarction (MI) and all-cause, cardiovascular disease (CVD), and ischemic heart disease (IHD) mortality.DesignPopulation-based prospective cohort study.MethodsFor the analyses, we used a cohort of 1568 randomly selected men, with sex-hormone data participating in the fourth Tromsø Study (1994–1995). Defined end points were first-ever MI (fatal or nonfatal), all-cause, CVD, and IHD mortality. A committee performed thorough ascertainment of end points, following a detailed protocol. Complete ascertainment of end points was until 30 September 2007 for all-cause mortality, until 31 December 2005 for CVD/IHD mortality, and until 31 December 2004 for first-ever MI. The prospective association between total and free testosterone and end points were examined using Cox proportional hazard regression, allowing for multivariate adjustment for age and cardiovascular risk factors...
Relationship of Endogenous Sex Hormones to Coronary Heart Disease: A Twin Study
The Journal of Clinical Endocrinology & Metabolism, 2004
We examined the association between endogenous sex hormones (estradiol, estrone, testosterone, and SHBG) and coronary heart disease (CHD) in white male twins. Stored plasma samples were available for 566 participants of the National Heart, Lung, and Blood Institute Twin Study, a longitudinal study of cardiovascular disease in male twins. Twenty-eight of these individuals were lost to follow-up, and outcome data were missing. Of the remaining 538 participants, 78 had CHD at baseline, and 154 subsequently developed CHD over 20 yr of follow-up. We observed no differences in mean unadjusted or age-and body mass index-adjusted log-transformed sex hormone concentrations for participants with and without CHD (all P > 0.08). Quartile and median split analyses revealed no significant association between any of the sex hormones and either prevalent or incident CHD. The discordant monozygotic twins showed no significant case-control group difference in estradiol, estrone, testosterone, and SHBG (all P > 0.3). The positive and negative concordant twin pairs had similar values for each of the sex hormones (all P > 0.3). We observed no relationship between endogenous sex hormone concentrations and prevalent or incident CHD in this sample of male twins. (J Clin Endocrinol
Ischemic heart disease in women and the role of hormone therapy
International Journal of Cardiology, 2004
The prevalence of ischemic heart disease (IHD) has been increasing among the women in developed countries. The well recognized IHD excess in men has often obscured the fact that IHD is the leading cause of death in women. Women have atypical symptoms of IHD that lead to a delay in the diagnosis and an overall poor prognosis. Women have a delay in the onset of IHD due to the beneficial effects of their sex hormones. Postmenopausal women lose this beneficial effect of estrogen and undergo significant changes in their lipid profile, arterial pressure, glucose tolerance, and vascular reactivity that increase their risk for development of IHD. Recently there has been considerable interest in the sex hormones and their role in IHD in women. The general belief that hormone replacement therapy (HRT) has an overall beneficial effect on cardiovascular disease (CVD) in women and hence decreases CVD mortality and morbidity has not been shown in the recent multicenter prospective studies. With the availability of various types of estrogen and progestins, physicians prescribing these agents should take into consideration their varying effects on the cardiovascular system. Risk factor modifications should include diet, weight loss, regular exercise, smoking cessation and adequate control of hypertension (HTN), diabetes (DM) and hyperlipidemia. In the appropriate setting, treatment with proven beneficial agents like aspirin, h-blockers, angiotensin converting enzyme (ACE) inhibitors and statins will help decrease the burden of IHD in women. D
Life Sciences, 2019
Duration of endogenous estrogen exposure is apparently associated with risk of cardiovascular disease, the longer durations being more cardiovascular disease protective in women. We aimed to investigate the association of cumulative duration of endogenous estrogen exposure over women's reproductive lifespans with cardiovascular disease outcomes. Main methods For the purpose of the present study, of 10192 female participants, after excluding those using HRT (n=84), 3656 women, aged ≥ 30 years, who met eligibility criteria were selected and divided into three groups based on tertiles (T1,T2,T3) of exposure durations to endogenous estrogen. Cox proportional hazards regression model was used to estimate associations between exposure durations and cardiovascular disease outcomes. Key findings Cardiovascular events occurred in 352 participants over a median follow-up of 14.2(13.5, 14.6) years (7.7 per 1000 person years; 95%
Review paper Cardiovascular and metabolic effects of estrogen in men
Although in men with an inherited mutation of gene encoding ERα (estrogen resistance) the occurrence of premature coronary artery disease was documented, and in men with inherited lack of aromatase (estrogen deficiency) an unfavorable lipid milieu was reported, the predominant number of both epidemiological and interventional studies suggests that in men estrogens may either not influence or may promote the develpoment of coronary artery disease. It is possible therefore the beneficial effect of estrogen administration on the lipid milieu in patients with estrogen deficiency is limited only to this unique situation. There may exist a sex-specific difference in the response to estrogen action. In contrast to women where estrogens generate nitric oxide (NO) production in the vascular endothelium, they do not do so in men. NO is responsible for vascular dilation and inhibits lipoprotein oxydation and monocyte adhesion to the endothelium. There may exist also a difference between short-term, non-genomic effect of estrogen and the effects of a long-term exposition to the hormone. Several reports are available indicating that estrogen administartion may have an unfavourable effect not only on blood lipid profile but also on venous thromboembolism in both sexes. In this context the role of estrogens in the regulation of the cardiovascular system gains a special importance and needs further studies.
Estrogen plus Progestin and the Risk of Coronary Heart Disease
New England Journal of Medicine, 2003
Recent randomized clinical trials have suggested that estrogen plus progestin does not confer cardiac protection and may increase the risk of coronary heart disease (CHD). In this report, we provide the final results with regard to estrogen plus progestin and CHD from the Women's Health Initiative (WHI).