Abstract:
The incidence of hypertension and cardiovascular diseases is lower in women than age-matched men,
before women go through menopause. It has been suggested that low estradiol levels in postmenopausal women may be the culprit for the
risk of cardiovascular diseases, which prompted the use of hormone replacement therapy as a prevention
of hypertension and cardiovascular diseases after menopause.
However, recent results from women health initiative study showed that the risk of cardiovascular events
after the hormone replacement therapy was increased for myocardial infarction, stroke, deep venous thrombosis and pulmonary embolism in the conjugated equine estrogens (CEE) 0.625 mg daily plus medroxyprogesterone acetate (MPA) 2.5 mg daily administration, and for the deep venous thrombosis, pulmonary embolism and stroke in the conjugated equine estrogens (CEE) 0.625 mg daily administration.
After menopause, not only the estradiol levels decrease, but androgens remain unchanged or even
elevated. It is therefore proposed that an increase in the androgen/estrogen ratio may be the pathogenic
mechanism for cardiovascular diseases after menopause.
Experimental studies indicate that a relative increase of androgens after menopause may lead to metabolic syndrome, endothelial dysfunction, activation of the sympathetic nervous system and the renin
angiotensin system. All these mechanisms act in concert to promote hypertension and cardiovascular
diseases.
Therefore, targeting androgens after menopause may be beneficial for reduction of cardiovascular
risk in postmenopausal women.
