THE ROLE OF REPRODUCTIVE HORMONES IN VASCULAR-DISEASE AND HYPERTENSION

Review of pertinent research demonstrates a link between sex steroids and vascular disease. Evidence for this association includes: benefici al effect of estrogens on the blood lipids (elevation of high-density lipoproteins and lowering of low-density lipoproteins), adverse effect of high-dose synthetic estrogens on coagulation, vasodilating action of progesterone, and adverse effect of androgens and androgen-derived progestagens on lipoproteins. Natural steroids appear to differ in the ir impact from synthetic compounds; endogenous hormones from exogenous and parenterally administered preparations. Furthermore, steroids hav e different effects at different concentrations, doses, and ratios. Th eir actions also vary according to age, sex, pregnant or nonpregnant s tate, body weight, smoking, and other risk factors. In this article, t he following areas will be considered in relation to the impact of sex steroids on cardiovascular phenomena and hypertension: menstrual cycl e and its disturbances; amenorrhea and hyperandrogenism; pregnancy wit h its hyperdynamic state and a tendency to gestational hypertension; o ral-contraception-induced, dose-related thromboembolic phenomena, meno pause and estrogen deficiency states with increased incidence of ather ogenesis; estrogen replacement therapy with its decrease in cardiovasc ular morbidity; other hormonal therapies which induce hypoestrogenism with its consequences. The evidence is emerging that hormonal modifica tions may be useful in the prevention of cardiovascular morbidity.