Replacement Therapy Targeting of the Renin-Angiotensin System as an Adjunct to Estrogen (original) (raw)
C ardiovascular diseases are the leading cause of death in women and claim the lives of more than half a million women every year. The incidence of cardiovascular disease is 4-fold higher in postmenopausal women than in women of the same age who are premenopausal. 1 Hypertension is a major risk factor for cardiovascular disease. It has been shown that after adjustment for age and body mass index, postmenopausal women are more than twice as likely to be hypertensive as premenopausal women. 2 Evidence that hypertensive postmenopausal women are more salt-sensitive than normotensive postmenopausal women 3 suggests that decreases in ovarian hormone levels and increased sensitivity to dietary sodium may be important factors in the genesis of postmenopausal hypertension. Thus, after menopause, hypertension may contribute to the increase in cardiovascular risk of postmenopausal women. The mechanisms responsible for the increase in blood pressure after menopause are still under investigation. In the United States alone, Ϸ38% of postmenopausal, 6 or 10 million, women use some form of hormone replacement therapy. There is quite a bit of controversy over the cardiovascular health benefits of estrogen replacement therapy, especially in light of the cessation of the estrogen-alone component of the National Heart, Lung and Blood Institutefunded Women's Health Initiative (WHI) hormone trial earlier this year. Results of the nearly 7-year follow-up of 11 000 healthy postmenopausal women using conjugated equine estrogen or placebo who had a hysterectomy showed an increased risk of stroke and no reduction in the risk of coronary heart disease. 7 Additionally, the estrogen plus progestin trial of the WHI had been stopped 2 years earlier when an increased risk of breast cancer, heart disease, stroke, and blood clots were determined to outweigh the benefits of reduced risks of hip fracture and colorectal cancer in women who had a uterus. These studies have sparked a worldwide scare over the risks of hormone replacement therapy. However, potential flaws in the study should be noted in that the subjects in the WHI trial were in their 60s and early 70s and had long since gone through menopause and may have had asymptomatic cardiovascular disease (or atherosclerosis) when the study was initiated. Additionally, these clinical studies did not address a role for modulation of the renin-angiotensin system by estrogen. Therefore, there continues to be a need for continued basic research and new clinical trials on the cardiovascular effects of hormone replacement therapy.
Sign up for access to the world's latest research.
checkGet notified about relevant papers
checkSave papers to use in your research
checkJoin the discussion with peers
checkTrack your impact
Loading Preview
Sorry, preview is currently unavailable. You can download the paper by clicking the button above.