Abstract
Among the known cardiovascular risk factors, high low-density lipoprotein (LDL) cholesterol and low high-density lipoprotein (HDL) cholesterol are important predictors of atherosclerotic disease. Analysis of data from observational studies initially suggested that the cardioprotective effect of estrogen was due to estrogen-induced changes in serum lipoproteins [1]. After menopause, LDL levels rise while HDL levels decline [2], thus worsening the LDL-to-HDL ratio and accelerating the development of atherosclerotic disease. Estrogen replacement results in lower levels of total cholesterol, decreased levels of LDL cholesterol, increased levels of HDL cholesterol, and increased levels of triglycerides [3,4]. Estrogen stimulates the liver to increase syntheses of VLDL which results in higher blood triglyceride levels. However, estrogen also stimulates hepatic receptor-mediated clearance of highly atherogenic LDL cholesterol. Another beneficial effect of estrogen is increased synthesis of apolipoprotein A1 and A2 which results in higher blood levels of HDL cholesterol. This effect is also due to decreased clearance of HDL cholesterol, leading to increased blood HDL levels and increased clearance of tissue cholesterol by the reverse cholesterol transport pathway.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Bush TL. The epidemiology of cardiovascular disease in postmenopausal women. Ann NY Acad Sci 1990;592:263–271.
Sacks FM, Walsh BW. The effect of reproductive hormones on serum lipoproteins: Unresolved issues in biology and clinical practice. Ann NY Acad Sci 1990;592:272–285.
Walsh BW, Schiff I, Rosner B, et al. Effects of postmenopausal estrogen replacement on the concentrations and metabolism of plasma lipoproteins. N Engl J Med 1991;325:1196–1204.
Colvin PL, Auerbach BJ, Case LD et al. A dose-response relationship between sex hormone-induced change in hepatic triglyceride lipase and high-density lipoprotein cholesterol in postmenopausal women. Metabolism 1991;40:1052–56.
The Writing Group for the PEPI Trial. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. JAMA 1995;273:199–208.
Darling GM, Johns JA, McCloud PI, Davis SR. Estrogen and progestin compared with simvastatin for hypercholesterolemia in postmenopausal women. N Engl J Med 1997;337: 595–601.
Davidson MH, Testolin LM, Maki KC, vonDuvillard S, Drennan KB. A comparison of estrogen replacement, pravastatin, and combined treatment for the management of hypercholesterolemia in postmenopausal women. Arch Intern Med 1997;157:1186–92.
Clarkson TB, Anthony MS, Jerome CP. Lack of effect raloxifene on coronary artery atherosclerosis of postmenopausal monkeys, J Clin Endocrinol Metab 1998;83:721–26.
Sacks FM, McPherson R, Walsh BW, et al. Effect of postmenopausal estrogen replacement on plasma Lp(a) lipoprotein concentrations. Arch Intern Med 1994;154:1106–10.
Sacks MN, Rader DJ, Cannon RO, et al. Oestrogen and inhibition of oxidation of low-density lipoproteins in postmenopausal women. Lancet 1994;343:269–70.
Adams MR, Williams JK, Clarkson TN, et al. Effects of oestrogens and progestogens on coronary atherosclerosis and osteoporosis of monkeys. Bailliere’s Clinical Obstetrics and Gynaecology 1991;5:915–34.
Fowlkes L, Sullivan JM. Estrogens, blood pressure and cardiovascular disease. Cardiol Rev 1995;3(2):106–14.
Gordon EM, Williams SR, Frenchek B, Mazur CA, Speroff L. Dose-dependent effects of postmenopausal estrogen and progestin on antithrombin III and factor XII. J Lab Clin Med 1988;111:52–56.
Alkjaersig N, Fletcher AP, De Ziegler D, Steingold KA, Meldrum DR, Judd HL. Blood coagulation in postmenopausal women given estrogen treatment: Comparison of transdermal and oral administration. J Lab Clin Med 1988;111:224–28.
Bar J, Tepper R, Fuchs J, Pardo J, Goldberger S, Ovadia J. The effect of estrogen replacement therapy on platelet aggregation and adenosine triphosphate release in postmenopausal women. Obstet Gynecol 1993;81:261–64.
Gilabert J, Estelies A, Cano A, et al. The effect of estrogen replacement therapy with or without progestogen on the fibrinolytic system and coagulation inhibitors in postmenopausal status. Am J Obstet Gynecol 1995;173(6):1849–54.
Gebara OCE, Mittleman MA, Sutherland P, et al. Association between increased estrogen status and increased fibrinolytic potential in the Framingham Offspring Study. Circulation 1995;91:1952–58.
Koh KK, Mincemoyer R, Bui MN, et al. Effects of hormone-replacement therapy on fibrinolysis in postmenopausal women. N Engl J Med 1997;336:683–90.
Chetkowski RJ, Meldrum DR, Steingold KA, et al. Biologic effects of transdermal estradiol. N Engl J Med 1986;314:1615–20.
Poller L, Thomson JM, Coope J. Conjugated equine estrogens and blood clotting: A followup report. Br Med J 1977;1:935–36.
Stangel JJ, Innerfield I, Reyniak J, Stone ML. The effect of conjugated estrogens on coagulability in menopausal women. Obstet Gynecol 1977;49:314–16.
Nabulsi AA, Ch B, Folsom AR, et al. Association of hormone-replacement therapy with various cardiovascular risk factors in postmenopausal women. N Engl J Med 1993;328:1069–75.
Fogelberg M, Vesterqvist O, Dicfalusy U, et al. Experimental atherosclerosis: Effects of oestrogen and atherosclerosis on thromboxane and prostacyclin formation. Eur J Clin Invest 1990;20:105–10.
Daly E, Vessey MP, Hawkins MM, Carson JL, Gough P, Marsh S. Increased risk of venous thromboembolism in hormone replacement therapy users. Lancet 1996;348:977–80.
Jick H, Jick SS, Gurewich V, Myers MW, Vasilakis C. Risk of idiopathic venous thromboembolism among users of postmenopausal estrogens. Lancet 1996;348:981–82.
Grodstein F, Stampfer MJ, Goldhaber SZ, et al. Prospective study of exogenous hormones and risk of pulmonary embolism in women. Lancet 1996;348:983–87.
Rights and permissions
Copyright information
© 1999 Kluwer Academic Publishers and Fondazione Giovanni Lorenzini
About this chapter
Cite this chapter
Sullivan, J.M. (1999). Action of Specific Estrogens on the Coronary Artery: Effects on Lipoproteins, Coagulation, and Fibrinolysis. In: Women’s Health and Menopause. Medical Science Symposia Series, vol 13. Springer, Dordrecht. https://doi.org/10.1007/978-0-585-37973-9_14
Download citation
DOI: https://doi.org/10.1007/978-0-585-37973-9_14
Publisher Name: Springer, Dordrecht
Print ISBN: 978-0-7923-5906-7
Online ISBN: 978-0-585-37973-9
eBook Packages: Springer Book Archive