Menopausal hormone therapy: currently no evidence for cardiac protection

Impact of menopause and diabetes on atherogenic lipid profile: is it worth to analyse lipoprotein subfractions to assess cardiovascular risk in women?

Cardiovascular disease is the leading cause of death in women at advanced age, who are affected a decade later compared to men. Cardiovascular risk factors in women are not properly investigated nor treated and events are frequently lethal. Both menopause and type 2 diabetes substantially increase cardiovascular risk in the female sex, promoting modifications on lipid metabolism and circulating lipoproteins. Lipoprotein subfractions suffer a shift after menopause towards a more atherogenic lipid profile, consisted of hypertriglyceridemia, lower levels of both total high density lipoprotein (HDL) and its subfraction HDL2, but also higher levels of HDL3 and small low-density lipoprotein particles. This review discusses the impact of diabetes and menopause to the lipid profile, challenges in lipoprotein subfractions determination and their potential contribution to the cardiovascular risk assessment in women. It is still unclear whether lipoprotein subfraction changes are a major driver of cardiometabolic risk and which modifications are predominant. Prospective trials with larger samples, methodological standardizations and pharmacological approaches are needed to clarify the role of lipoprotein subfractions determination on cardiovascular risk prediction and intervention planning in postmenopausal women, with or without DM.

Cardiovascular risk assessment with oxidised LDL measurement in postmenopausal women receiving intranasal estrogen replacement therapy

OBJECTIVE

To investigate the effect of intranasal estrogen replacement therapy administered to postmenopausal women alone or in combination with progesterone on markers of cardiovascular risk.

METHODS

The study was conducted with 44 voluntary postmenopausal women. In group I (n = 15), the patients were treated with only intranasal estradiol (300 μg/day estradiol hemihydrate). In group II (n = 11), the patients received cyclic progesterone (200 mg/day micronized progesterone) for 12 days in each cycle in addition to continuous intranasal estradiol. Group III (n = 18) was the controls. Serum lipid profiles, oxidised low-density lipoprotein (LDL) and other markers of cardiovascular risk were assessed at baseline and at the 3rd month of the treatment.

RESULTS

Lipid profile, LDL apolipoprotein B, lipoprotein a, homocysteine, oxidised LDL values and oxidised LDL/LDL cholesterol ratio were not observed to change after 3 months compared to baseline values within each group (p > 0.016). In comparison to changes between the groups after the treatment, only oxidised LDL levels and oxidised LDL/LDL cholesterol ratios of group II were increased compared to control group (p < 0.05).

CONCLUSIONS

Intranasal estradiol alone did not appear to have an effect on markers of cardiovascular risk in healthy postmenopausal women. However, the addition of cyclic oral micronized progesterone to intranasal estradiol influenced the markers of cardiovascular risk negatively in comparison to non-users in healthy postmenopausal women.

Estrogen receptor alpha and beta are both involved in the cerebral VEGF/Akt/NO pathway and cerebral angiogenesis in female mice

We have previously demonstrated that vascular endothelial growth factor (VEGF) is critical for cerebral angiogenesis in middle-aged female rats and may play a role in the flow-preserving neuroprotective actions of estrogen through its angiogenic and antiapoptotic properties. Here, we attempt to elucidate the effects of estrogen and the specific estrogen receptor (ER) subtype in cerebral VEGF/Akt/NO pathways and cerebral angiogenesis using 15-week old female mice that are either wild-type (WT), lack estrogen receptor α (ERαKO) or β (ERβKO). Protein levels of VEGF and basic signaling molecules of VEGF angiogenic pathway in the frontal cortex were expressed as follows, as revealed by ELISA and immunoblotting : a) VEGF; WT: ERαKO: ERβKO, 47 ± 15: 27 ± 5: 28 ± 5 pg/mg, respectively (P < 0.01); b) KDR decreased about 40% in both ERαKO and ERβKO compared to WT; c) Akt was significantly down-regulated in both ERαKO and ERβKO compared to WT; d) phosphorylated Akt (pAkt); WT: ERαKO: ERβKO, 0.6 ± 0.2: 0.3 ± 0.01: 0.3 ± 0.1 units/mg, respectively; e) phosphorylated eNOS significantly decreased about 45% in both ERαKO and ERβKO compared to WT. Cerebral capillary density decreased in both ERαKO and ERβKO compared to WT. Thus, it can be concluded that in female mice, VEGF/Akt/eNOS pathway plays an important role in cerebral angiogenesis and that both ER subtypes are involved in the regulation of VEGF and its signaling molecule expression in the frontal cortex.

Raloxifene, soy phytoestrogens and endothelial function in postmenopausal women

OBJECTIVE

To compare the effects of raloxifene and soy phytoestrogens on endothelial function in healthy, postmenopausal women.

DESIGN

Randomized, double-blind, placebo-controlled, cross-over trial. Subjects (n = 22; mean age 58.5 years) underwent endothelial function testing at baseline and following 6 weeks of daily raloxifene 60 mg, soy phytoestrogens 55 mg, and placebo in random sequence with intervening 6-week wash-out periods. Endothelial function was assessed as flow-mediated vasodilatation (FMD) of the brachial artery using high-resolution ultrasound; digital flux was measured with laser Doppler velocimetry.

RESULTS

Baseline (pretreatment) FMD was almost within normal range at 9.6% (+/-6.4). FMD did not change from baseline within any treatment group, and no between-group differences were detected. FMD values following treatment with raloxifene, soy, and placebo were 10.3% (+/-12.3), 8.3% (+/-7.7), and 9.5% (+/-4.4), respectively. Area under curve ratios showed no treatment differences for digital velocimetry.

CONCLUSIONS

In this study, neither raloxifene nor soy enhanced endothelial function in postmenopausal women. However, the cohort had relatively normal endothelial function at baseline. Further study is required to determine if particular subgroups of postmenopausal women derive vascular benefit from the use of selective estrogen receptor modulators or soy phytoestrogens.

Effect of 17-β-estradiol administration during adriamycin-induced cardiomyopathy in ovariectomized rat

The incidence of cardiovascular diseases in humans differs in relation to the age of the patient. Although women suffer less than men from cardiovascular disorders during 15-55 years, after this period the incidence is equivalent in both sexes. This data suggests a cytoprotective effect of estrogens against cardiovascular disease. The estrogens, especially 17-beta-estradiol, are important antioxidant molecules with potential cytoprotective properties during oxidant/antioxidant disbalance induced by oxidative stress. Oxidative stress is often the underlying mechanism during vascular alterations and cardiac damage. The present study evaluated the role of ovariectomy and/or 17-beta-estradiol administration on antioxidant status and lipid peroxidation during cardiac injury induced by adriamycin. Different parameters were measured, including hemodynamic response (arterial pressure and cardiac frequency), lipid peroxidation products (malondialdehyde), protein carbonylation, antioxidant status (reduced glutathione, glutathione peroxidase, superoxide dismutase and catalase), and cardiac injury (creatinine kinase, lactate dehydrogenase, aspartate and alanine aminotransferase). Our study showed that 17-beta-estradiol reduced all of the parameters related to oxidative stress and cardiac injury in ovariectomized rats treated with adriamycin.