Abstract
Observational studies have shown a protective effect of estrogen replacement on risk of cardiovascular disease in postmenopausal women. The estrogen protection is thought to be mediated by mechanisms acting at different levels, including a beneficial effect on plasma lipid concentrations. Selective estrogen receptor modulators (SERM) share with estrogen the ability to reduce plasma levels of atherogenic lipoproteins like low-density lipoproteins and lipoprotein(a). The recent publication of the first randomized, placebo-controlled trial of estrogen/progestin replacement (HERS), which failed to show a reduced number of cardiovascular events in women randomized to estrogen treatment as compared with placebo, has cast some doubts on the protective role of estrogen. Other large randomized studies on the effect of estrogen and other compounds with estrogenic activity (eg, SERM) on cardiovascular disease risk are currently underway and will provide more definite answers to both clinicians and postmenopausal women.
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Kannel WB, Hjortland MC, McNamara PM: Menopause and the risk of cardiovascular disease: The Framingham Study. Ann Intern Med 1976, 85:447–452.
Colditz GA, Willett WC, Stampfer MJ, et al.: Menopause and the risk of coronary artery disease. N Engl J Med 1987, 316:1105–1110.
Nabulsi AA, Folsom AR, White A, et al.: Association of hormone-replacement therapy with various cardiovascular risk factors in postmenopausal women. N Engl J Med 1993, 328:1069–1075.
Bush TL, Barrett-Connor E, Cowan LD, et al.: Cardiovascular mortality and non-contraceptive use of of estrogen in women: results from the Lipid Research Clinics Program Follow-up Study. Circulation 1987, 75:1102–1109.
Gruchow HW, Anderson AJ, Barboriak JJ, Sobocinski KA: Post-menopausal use of estrogen and occlusion of coronary arteries. Am Heart J 1988, 115:954–963.
The Writing Group for the PEPI Trial: Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. JAMA 1995, 273:199–208.
Seman LJ, deLuca C, Jenner JL, et al.: Lipoprotein(a)-cholesterol and coronary heart disease in the Framingham Heart Study. Clin Chem 1999, 45:1039–1046.
Seman LJ, McNamara JR, Schaefer EJ. Lipoprotein(a), homocysteine, and remanatlike particles: emerging risk factors. Curr Opin Cardiol 1999, 14:186–191.
Soma MR, Osnago-Gadda I, Paoletti R, et al.: The lowering of lipoprotein(a) induced by estrogen plus progesterone replacement therapy in postmenopausal women. Arch Intern Med 1993, 153:1462–1468.
Sacks FM, McPherson R, Walsh BW: Effect of postmenopausal estrogen replacement on plasma Lp(a) lipoprotein concentrations. Arch Intern Med 1994, 154:1106–1110.
Masuoka H, Ishikura K, Kamei S, et al.: Predictive value of remnant-like particles cholesterol/high-density lipoprotein cholesterol ratio as a new indicator of coronary artery disease. Am Heart J 1998, 136:226–230.
Weintraub M, Grosskopf I, Charach G, Eckstein N, Rubistein A: Hormone replacement therapy enhances postprandial lipid metabolism in postmenopausal women. Metabolism 1999, 48:1193–1196.
Bush TL, Miller VT: Effects of pharmacologic agents used during menopause: impact on lipids and lipoproteins. In Menopause: Physiology and Pharmacology. Edited by Mishell DR, Jr. Chicago: Year Book Medical Publishers; 1987, 187–208.
Crook D, Cust MP, Gangar MB, et al.: Comparison of transdermal and oral estrogen-progestin replacement therapy: effects on serum lipids and lipoproteins. Am J Obstet Gynecol 1992, 166:950–955.
Chait A, Brunzell JD: Chylomicronemia syndrome. Adv Intern Med 1991, 37:249–273.
Chang J, Powles TJ, Ashley SE, et al.: The effect of tamoxifen and hormone replacement therapy on serum cholesterol, bone mineral density, and coagulation factors in healthy postmenopausal women participating in a randomized, controlled tamoxifen prevention study. Ann Oncol 1996, 7:671–675.
Bagdade JD, Wolter J, Subbaiah PV, Ryan W: Effects of tamoxifen treatment on plasma lipids and lipoprotein composition. J Clin Endocrinol Metab 1990, 70:1132–1135.
Decensi A, Bonanni B, Guerrieri-Gonzaga, et al.: Biological activity of tamoxifen at low doses in healthy women. J Natl Cancer Inst 1998, 90:1461–1467.
Shewmon DA, Stock JL, Rosen CJ, et al.: Tamoxifen and estrogen lower circulating lipoprotein(a) concentrations in healthy postmenopausal women. Arterioscler Thromb 1994, 4:586–593.
Delmas PD, Bjarnasos NH, Mitlak BH, et al.: Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med 1997, 337:1641–1647.
Walsh BW, Kuller LH, Wild RA, et al.: Effects of raloxifene on serum lipids and coagulation factors in healthy postmenopausal women. JAMA 1998, 279:1445–1451.
Mijatovic V, van der Mooren MJ, Kenemans P, et al.: Raloxifene lowers serum lipoprotein(a) in healthy postmenopausal women: a randomized, double-blind, placebo-controlled comparison with conjugated equine estrogens. Menopause 1999, 6:134–137.
Stampfer MJ, Colditz GA. Estrogen replacement therapy and coronary heart disease: a quantitative assessment of the epidemiologic evidence. Prev Med 1991, 20:47–63.
Grady D, Rubin SM, Petitti DB, et al.: Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med 1992, 117:1016–1037.
Hulley S, Grady D, Bush T, et al.: Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 1998, 280:605–613.
Hemminki E, McPherson K: Impact of postmenopausal hormonal therapy on cardiovascular events and cancer: pooled data from clinical trials. Br Med J 1997, 315:149–153.
Sourander L, Rajala T, Raiha I, et al.: Cardiovascular and cancer morbidity and mortality and sudden cardiac death in postmenopausal women on oestrogen replacement therapy (ERT). Lancet 1998, 352:1965–1969.
Grodstein F, Stampfer MJ, Falkeborn M, et al.: Postmenopausal hormone therapy and risk of cardiovascular disease and hip fracture in a cohort of Swedish women. Epidemiology 1999, 5:476–480.
Teede HJ, Liang Y-L, Shiel LM, et al.: Hormone replacement therapy in postmenopausal women protects against smoking-induced changes in vascular structure and function. J Am Coll Cardiol 1999, 34:131–137.
Grady D: Postmenopausal hormone therapy: good for smokers? J Am Coll Cardiol 1999, 34:138–139.
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Lamon-Fava, S. Complete and selective estrogenic effects on lipids and cardiovascular disease. Curr Atheroscler Rep 2, 72–75 (2000). https://doi.org/10.1007/s11883-000-0097-x
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DOI: https://doi.org/10.1007/s11883-000-0097-x