ESTROGENS AND ATHEROSCLEROSIS

Estrogens prevent heart disease in women and have also been shown to r etard atherogenesis in animal models. Estrogens may act at several ste ps in the atherogenic process to prevent cardiovascular disease. Some of the benefits of estrogens can be ascribed to their ability to favor ably alter the lipoprotein profile, i.e. increase high-density lipopro tein and decrease low-density lipoprotein, and also to their ability t o prevent oxidative modification of low-density lipoprotein. Other ben eficial effects of estrogens include direct actions on the vascular en dothelium and vascular smooth muscle, leading to a decrease in the exp ression of adhesion molecules involved in monocyte adhesion to endothe lial cells, and to a decrease in certain chemokines involved in monocy te migration into the subendothelial space. Estrogens may also affect the later stages of atherogenesis. Finally, estrogens may modify the b ehavior of atherosclerotic vessels by altering their reactivity and th ereby promoting vasodilation, and this may also partly account for the ir ability to prevent clinical events due to cardiovascular disease.