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Estrogen and the Vascular Endothelium: The Unanswered Questions. Endocrinology 2023 Apr 17;164(6)

Date

05/20/2023

Pubmed ID

37207450

Pubmed Central ID

PMC10230790

DOI

10.1210/endocr/bqad079

Scopus ID

2-s2.0-85163898622 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

Premenopausal women have a lower incidence of cardiovascular disease (CVD) compared with their age-matched male counterparts; however, this discrepancy is abolished following the transition to menopause or during low estrogen states. This, combined with a large amount of basic and preclinical data indicating that estrogen is vasculoprotective, supports the concept that hormone therapy could improve cardiovascular health. However, clinical outcomes in individuals undergoing estrogen treatment have been highly variable, challenging the current paradigm regarding the role of estrogen in the fight against heart disease. Increased risk for CVD correlates with long-term oral contraceptive use, hormone replacement therapy in older, postmenopausal cisgender females, and gender affirmation treatment for transgender females. Vascular endothelial dysfunction serves as a nidus for the development of many cardiovascular diseases and is highly predictive of future CVD risk. Despite preclinical studies indicating that estrogen promotes a quiescent, functional endothelium, it still remains unclear why these observations do not translate to improved CVD outcomes. The goal of this review is to explore our current understanding of the effect of estrogen on the vasculature, with a focus on endothelial health. Following a discussion regarding the influence of estrogen on large and small artery function, critical knowledge gaps are identified. Finally, novel mechanisms and hypotheses are presented that may explain the lack of cardiovascular benefit in unique patient populations.

Author List

SenthilKumar G, Katunaric B, Bordas-Murphy H, Sarvaideo J, Freed JK

Authors

Julie K. Freed MD, PhD Vice Chair, Associate Professor in the Anesthesiology department at Medical College of Wisconsin
Jenna Sarvaideo DO Assistant Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Cardiovascular Diseases
Endothelium, Vascular
Estrogen Replacement Therapy
Estrogens
Female
Humans
Male
Menopause