This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Skafar, D. F. Articles by Sowers, J. R. Search for Related Content PubMed PubMed Citation Articles by Skafar, D. F. Articles by Sowers, J. R.

Female Sex Hormones and Cardiovascular Disease in Women¹

Departments of Physiology and Medicine (J.R.S.), Wayne State University, Detroit, Michigan 48201

Address all correspondence and requests for reprints to: James R. Sowers, M.D., Division of Endocrinology, Metabolism, and Hypertension, Wayne State University School of Medicine, 4201 St. Antoine, UHC-4H, Detroit, Michigan 48201. E-mail: sowers{at}oncgate.roc.wayne.edu

Cardiovascular disease is the leading cause of mortality in women, a fact that is underappreciated by women and physicians. Clinical and experimental data underscore the cardioprotective effects of female sex hormones, particularly estrogen. Indeed, the loss of female sex hormones after menopause contributes to the striking increase in the incidence of cardiovascular morbidity and mortality after menopause. Estrogen replacement therapy improved lipoprotein profiles in the postmenopausal women, but this accounts for less than half of the cardioprotective effects of estrogen replacement therapy. Addition of progestins to estrogen therapy in women appears not to significantly attenuate the cardioprotective effects of estrogen replacement therapy despite experimental data suggesting otherwise. This review addresses potential mechanisms, other than influences on lipoproteins, by which estrogen and progesterone exert their cardiovascular protective effects. Particular emphasis is directed to genomic and nongenomic effects of estrogen and progesterone that are exerted directly on cardiovascular tissue.

This article has been cited by other articles:

				R. Karim, H. N. Hodis, F. Z. Stanczyk, R. A. Lobo, and W. J. Mack Relationship between Serum Levels of Sex Hormones and Progression of Subclinical Atherosclerosis in Postmenopausal Women J. Clin. Endocrinol. Metab., January 1, 2008; 93(1): 131 - 138. [Abstract] [Full Text] [PDF]

				A. K. Natoli, T. L. Medley, A. A. Ahimastos, B. G. Drew, D. J. Thearle, R. J. Dilley, and B. A. Kingwell Sex Steroids Modulate Human Aortic Smooth Muscle Cell Matrix Protein Deposition and Matrix Metalloproteinase Expression Hypertension, November 1, 2005; 46(5): 1129 - 1134. [Abstract] [Full Text] [PDF]

				M. Karl, M. Potier, I. H. Schulman, A. Rivera, H. Werner, A. Fornoni, and S. J. Elliot Autocrine Activation of the Local Insulin-Like Growth Factor I System Is Up-Regulated by Estrogen Receptor (ER)-Independent Estrogen Actions and Accounts for Decreased ER Expression in Type 2 Diabetic Mesangial Cells Endocrinology, February 1, 2005; 146(2): 889 - 900. [Abstract] [Full Text] [PDF]

				K. Morimoto, Y. Kurahashi, K. Shintani-Ishida, N. Kawamura, M. Miyashita, M. Uji, N. Tan, and K.-i. Yoshida Estrogen replacement suppresses stress-induced cardiovascular responses in ovariectomized rats Am J Physiol Heart Circ Physiol, November 1, 2004; 287(5): H1950 - H1956. [Abstract] [Full Text] [PDF]

				A. Sierra-Ramirez, T. Morato, R. Campos, I. Rubio, C. Calzada, E. Mendez, and G. Ceballos Acute effects of testosterone on intracellular Ca2+ kinetics in rat coronary endothelial cells are exerted via aromatization to estrogens Am J Physiol Heart Circ Physiol, July 1, 2004; 287(1): H63 - H71. [Abstract] [Full Text] [PDF]

				J. Ren, K. K. Hintz, Z. K. F. Roughead, J. Duan, P. B. Colligan, B. H. Ren, K. J. Lee, and H. Zeng Impact of estrogen replacement on ventricular myocyte contractile function and protein kinase B/Akt activation Am J Physiol Heart Circ Physiol, May 1, 2003; 284(5): H1800 - H1807. [Abstract] [Full Text] [PDF]

				I. Boutin-Ganache, S. Picard, and C. F. Deschepper Distinct gene-sex interactions regulate adult rat cardiomyocyte width and length independently Physiol Genomics, December 26, 2002; 12(1): 61 - 67. [Abstract] [Full Text] [PDF]

				M Sitges, M Heras, E Roig, M Duran, M Masotti, M.J Zurbano, M Roque, and G Sanz Acute and mid-term combined hormone replacement therapy improves endothelial function in post-menopausal women with angina and angiographically normal coronary arteries Eur. Heart J., November 2, 2001; 22(22): 2116 - 2124. [Abstract] [PDF]

				Y. K. Hodges, L. Tung, X.-D. Yan, J. D. Graham, K. B. Horwitz, and L. D. Horwitz Estrogen Receptors {alpha} and {beta} : Prevalence of Estrogen Receptor {beta} mRNA in Human Vascular Smooth Muscle and Transcriptional Effects Circulation, April 18, 2000; 101(15): 1792 - 1798. [Abstract] [Full Text] [PDF]

				R. R. Freedman and R. Girgis Effects of Menstrual Cycle and Race on Peripheral Vascular {alpha}-Adrenergic Responsiveness Hypertension, March 1, 2000; 35(3): 795 - 799. [Abstract] [Full Text] [PDF]

				M. Elsheikh, R. Bird, B. Casadei, G. S. Conway, and J. A. H. Wass The Effect of Hormone Replacement Therapy on Cardiovascular Hemodynamics in Women with Turner's Syndrome J. Clin. Endocrinol. Metab., February 1, 2000; 85(2): 614 - 618. [Abstract] [Full Text]

				S. C. Lim, A. E. Caballero, S. Arora, P. Smakowski, E. M. Bashoff, F. M. Brown, F. W. Logerfo, E. S. Horton, and A. Veves The Effect of Hormonal Replacement Therapy on the Vascular Reactivity and Endothelial Function of Healthy Individuals and Individuals with Type 2 Diabetes J. Clin. Endocrinol. Metab., November 1, 1999; 84(11): 4159 - 4164. [Abstract] [Full Text]

				J. R. Kaseta, D. F. Skafar, J. L. Ram, S. J. Jacober, and J. R. Sowers Cardiovascular Disease in the Diabetic Woman J. Clin. Endocrinol. Metab., June 1, 1999; 84(6): 1835 - 1838. [Abstract] [Full Text]

				A. Cagnacci, L. Rovati, A. Zanni, S. Malmusi, F. Facchinetti, and A. Volpe Physiological doses of estradiol decrease nocturnal blood pressure in normotensive postmenopausal women Am J Physiol Heart Circ Physiol, April 1, 1999; 276(4): H1355 - H1360. [Abstract] [Full Text] [PDF]

				E. Simpson Why Do the Clinical Sequelae of Estrogen Deficiency Affect Women More than Men?a J. Clin. Endocrinol. Metab., June 1, 1998; 83(6): 2214 - 2215. [Full Text]

				K. N. Hogeveen, M. Talikka, and G. L. Hammond Human Sex Hormone-binding Globulin Promoter Activity Is Influenced by a (TAAAA)n Repeat Element within an Alu Sequence J. Biol. Chem., September 21, 2001; 276(39): 36383 - 36390. [Abstract] [Full Text] [PDF]