Cardiovascular disease in women: implications of hormone replacement therapy.

Abstract

Arterial dysfunction and disease affect a majority of women during their life time. Ovarian hormones inhibit the development of atherosclerosis and play an integral role in the maintenance of normal arterial function. Estrogens act in the liver to improve and maintain lipid profiles and also act in the walls of arteries and in cardiac myocytes to maintain function and prevent disease. Death from cardiovascular disease is reduced in women receiving estrogen replacement therapy (ERT). Ten-year follow-up studies of women with advanced coronary artery disease (CAD) show a marked reduction in fatalities among the women receiving estrogens compared with untreated women. Sublingual estradiol-17 beta compared with placebo results in improved exercise tolerance and reduced ischemia during exercise in women with CAD. Estradiol-17 beta infused into the coronary arteries in women with CAD leads to improved arterial function. Estrogen deficiency has been reported in women with angina pectoris who have normal coronary arteries, and these women respond to estrogen treatment. HRT implies the use of ERT with the addition of a progestin. Progestins oppose the actions of estrogens. Counter-effects of lipid metabolism appear to be minimal with progestins currently in use. Oppositional effects of progestins on hemodynamic actions of estrogens may be significant, as progestins appear to induce vasoconstriction of estrogenized vessels.