Menopause and Age-Related General Health Risk: A Woman’s Heart Needs Her Hormones

Abstract

Cardiovascular disease (CVD) is a leading cause of mortality for women and men, but there is a strong relationship between menopause and incidence of coronary heart disease (CHD) in women. This is believed to be mainly due to the significant decrease of estrogen secretion after menopause. Estrogen receptors are abundant throughout the cardiovascular system and exert long-lasting and rapid actions on it. Experimental data shows that estrogens are cardioprotective and can protect against ischemia and adverse remodeling. In blood vessels, estrogens cause vasodilation and decrease atherogenesis. Therefore, it is understandable that after menopause arterial function deteriorates which, together with unfavorable metabolic alterations, causes an increase in the risk of CHD. Animal studies clearly showed the positive effect of estrogens on cardiovascular function. However, the first large randomized clinical trials of hormone replacement therapy (HRT) conducted in women with established CHD did not show a decreased risk. Analysis of data from subsequent trials revealed that there is a place for exogenous estrogens in the primary prevention of CHD. The timing hypothesis suggests that the introduction of HRT soon after menopause significantly reduces CHD and mortality in primary prevention.