FEMALE SEX-HORMONES AND CARDIOVASCULAR-DISEASE IN WOMEN

Cardiovascular disease is the leading cause of mortality in women, a f act that is underappreciated by women and physicians. Clinical and exp erimental data underscore the cardioprotective effects of female sex h ormones, particularly estrogen. Indeed, the loss of female sex hormone s after menopause contributes to the striking increase in the incidenc e of cardiovascular morbidity and mortality after menopause. Estrogen replacement therapy improved lipoprotein profiles in the postmenopausa l women, but this accounts for less than half of the cardioprotective effects of estrogen replacement therapy. Addition of progestins to est rogen therapy in women appears not to significantly attenuate the card ioprotective effects of estrogen replacement therapy despite experimen tal data suggesting otherwise. This review addresses potential mechani sms, other than influences on lipoproteins, by which estrogen and prog esterone exert their cardiovascular protective effects. Particular emp hasis is directed to genomic and nongenomic effects of estrogen and pr ogesterone that are exerted directly on cardiovascular tissue.