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The Influence of Sex Steroids on Affairs of the Heart

  • Chapter
Frontiers in Gynecological Endocrinology

Part of the book series: ISGE Series ((ISGE))

Abstract

Coronary heart disease (CHD) is a leading cause of death in women. Ovarian failure leads to an increased risk of CHD, and therefore sex steroid replacement with hormone replacement therapy (HRT) should help prevent this. There is abundant evidence for the beneficial effects of estrogen on metabolic risk factors for CHD such as lipids and lipoproteins and glucose and insulin. There is also strong support for the beneficial direct arterial effects of estrogen through a variety of mechanisms. Thus the biological plausibility for a beneficial effect of estrogen on the cardiovascular system is overwhelming. Observational studies have consistently shown an association between postmenopausal HRT use and a reduction in CHD, both in primary and in secondary prevention. Some randomized clinical trials have not demonstrated significant benefit of HRT for CHD reduction, particularly in secondary prevention. However, it has emerged that the timing of initiation of HRT after menopause and the starting dose of estrogen may be crucial. HRT started in the early postmenopause reduces the risk of CHD, but may have a detrimental effect when started in older women with established CHD. This adverse effect is most likely due to inappropriately high doses of estrogen being given to the older women, resulting in increased coagulation activation and adverse vascular remodeling. The totality of the evidence now suggests that HRT is effective in CHD prevention, provided that age-appropriate doses are used and treatment is preferably initiated soon after menopause.

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Author information

Authors and Affiliations

  1. National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK

    John C. Stevenson

  2. Department of Gynaecology, Chelsea and Westminster Hospital NHS Foundation Trust, Fulham Road, London, SW10 8NH, UK

    Marie O. Gerval

  3. Royal Brompton and Harefield NHS Foundation Trust, London, SW3 6NP, UK

    Marie O. Gerval

Authors
  1. John C. Stevenson
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  2. Marie O. Gerval
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Correspondence to John C. Stevenson .

Editor information

Editors and Affiliations

  1. International Society of Gynecological Endocrinology, Pisa, Italy

    Andrea R. Genazzani

  2. Department of Obstetrics and Gynaecology, Mater Dei Hospital, Birkirkara, Malta

    Mark Brincat

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© 2014 Springer International Publishing Switzerland

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Stevenson, J.C., Gerval, M.O. (2014). The Influence of Sex Steroids on Affairs of the Heart. In: Genazzani, A.R., Brincat, M. (eds) Frontiers in Gynecological Endocrinology. ISGE Series. Springer, Cham. https://doi.org/10.1007/978-3-319-03494-2_22

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  • DOI: https://doi.org/10.1007/978-3-319-03494-2_22

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-03493-5

  • Online ISBN: 978-3-319-03494-2

  • eBook Packages: MedicineMedicine (R0)

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