Hormone therapy and the cardiovascular system

Towards a personalised approach in exercise-based cardiovascular rehabilitation: How can translational research help? A 'call to action' from the Section on Secondary Prevention and Cardiac Rehabilitation of the European Association of Preventive Cardiology

The benefit of regular physical activity and exercise training for the prevention of cardiovascular and metabolic diseases is undisputed. Many molecular mechanisms mediating exercise effects have been deciphered. Personalised exercise prescription can help patients in achieving their individual greatest benefit from an exercise-based cardiovascular rehabilitation programme. Yet, we still struggle to provide truly personalised exercise prescriptions to our patients. In this position paper, we address novel basic and translational research concepts that can help us understand the principles underlying the inter-individual differences in the response to exercise, and identify early on who would most likely benefit from which exercise intervention. This includes hereditary, non-hereditary and sex-specific concepts. Recent insights have helped us to take on a more holistic view, integrating exercise-mediated molecular mechanisms with those influenced by metabolism and immunity. Unfortunately, while the outline is recognisable, many details are still lacking to turn the understanding of a concept into a roadmap ready to be used in clinical routine. This position paper therefore also investigates perspectives on how the advent of 'big data' and the use of animal models could help unravel inter-individual responses to exercise parameters and thus influence hypothesis-building for translational research in exercise-based cardiovascular rehabilitation.

Ligusticum chuanxiong Prevents Ovariectomy-Induced Liver and Vascular Damage in Rats

Post-menopause, there is an increase in body weight, visceral adiposity, and risk of developing non-alcoholic fatty liver disease (NAFLD), which leads to various cardiovascular diseases (CVDs). Some natural products have proven useful for counteracting the detrimental effects of menopause. The rhizome of Ligusticum chuanxiong Hort. (LC) is a well-known medicinal herb widely used in Chinese communities for the treatment of CVDs. The hepatic and vascular protective effects of LC ethanolic extract under postmenopausal conditions were investigated on ovariectomized (OVX) rats supplemented with or without LC ethanolic extract (600 mg/kg body weight/day, p.o.) or 17β-estradiol (1 mg/kg body weight/day, p.o.) for 12 weeks. The current findings demonstrated that consumption of LC ethanolic extract could reduce the body weight gain, improve serum lipid profile (lowering low density lipoprotein cholesterol but raising high density lipoprotein cholesterol), combat NAFLD, and protect vascular endothelium in the OVX rats. The beneficial effects of LC may be associated with its antioxidant or vasorelaxant compounds, which enhance the levels of hepatic antioxidant enzymes and up-regulate endothelial nitric oxide synthase mRNA expression, respectively. Taken together, LC may be a promising natural supplement for postmenopausal women to prevent NAFLD and CVDs.

Aqueous extract of danshen (Salvia miltiorrhiza Bunge) protects ovariectomized rats fed with high-fat diet from endothelial dysfunction

OBJECTIVE

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in postmenopausal women. Danshen, the dried root of Salvia miltiorrhiza Bunge, has been used clinically in China to treat CVD and dyslipidemia in postmenopausal women, and its major active ingredients have been found to have an estrogenic effect. The aim of this study was to elucidate the underlying mechanism of danshen's protective effects on vascular function in an ovariectomized (OVX) hyperlipidemic rat model.

METHODS

Thirty-five 6-month-old female Sprague-Dawley rats were randomly divided into five groups: sham-operated rats with low-fat control diet + vehicle, sham-operated rats with high-fat diet (HFD) + vehicle, OVX rats with HFD + vehicle, OVX rats with HFD + 17β-estradiol (1 mg kg d, PO), and OVX rats with HFD + danshen aqueous extract (600 mg kg d, PO). After 12 weeks of treatment, gains in body weight and serum lipid profile levels in rats were measured and histological examination of livers was carried out. Vascular function was evaluated by measuring relaxation responses. Molecular mechanisms were also analyzed in isolated aorta.

RESULTS

Treatment with danshen aqueous extract reduced body weight gain, improved serum lipid profiles, and prevented formation of fatty liver induced by HFD and OVX. In addition, danshen could increase endothelial-dependent vasorelaxation and displayed vasoprotection in OVX rats fed with HFD, primarily by stimulating nitric oxide (NO) production, up-regulating the mRNA expression of endothelial NO synthase, and down-regulating the mRNA expression of tumor necrosis factor α, intercellular cell adhesion molecule-1, and vascular cell adhesion molecule-1 in the isolated aortas.

CONCLUSIONS

We conclude for the first time that danshen aqueous extract could protect OVX rats fed with HFD from endothelial dysfunction. Its effect may be related to its abilities to normalize serum lipid profiles and enhance NO availability in the vascular system. Our findings indicate that danshen aqueous extract could be a promising natural supplement for postmenopausal women for preventing CVD.

Pharmacodynamic evaluation of oral estradiol nanoparticles in estrogen deficient (ovariectomized) high-fat diet induced hyperlipidemic rat model

PURPOSE

It is believed that estrogen deficiency contributes importantly to the pathogenesis of menopausal metabolic syndrome and symptoms can be ameliorated with estradiol therapy. The present study reports efficacy of 17-beta estradiol encapsulated nanoparticles in treating the postmenopausal dyslipidemic condition.

MATERIALS AND METHODS

Estradiol encapsulated poly(lactide-co-glycolide) (PLGA) nanoparticles were prepared by emulsion-diffusion-evaporation method and evaluated in estrogen deficient (ovariectomized) high fat diet induced hyperlipidemic rat model.

RESULTS

The results obtained showed that estradiol nanoparticles were equally/more effective in treatment of estrogen deficient hyperlipidemic conditions at three times reduced dose and frequency in comparison to that of drug suspension administered orally.

CONCLUSION

Together, these results demonstrate the ability of nanoparticles in improving oral bioavailability/efficacy of estradiol.

Effects of estro-progestagens on lipid and hormonal profiles in women with premature primary ovarian failure

Introduction Premature primary ovarian failure (PPOF) is defined as cessation of menstruation before the age of 40, Women with PPOF have hypergonadotropic amenorrhea and hypoestrogenia. The incidence of PPOF is 0.9-3%, and its etiology is midtifactorial (genetic, enzyme deficit, virus infections, autoimmune diseases and idiopathic). PPOF is an independent risk factor for cardiovascular diseases. Untreated women are at higher risk for coronary disease, due to increase of total cholesterol, LDL, triglycerides and decrease of HDL. The aim of this investigation was to study effects of estro-progestagens on lipid and hormonal profiles in PPOF.: Material and methods. This study included: 30 healthy women aged 41 ?2.3 years; body mass index 25?3.2 kg; hip/waist ratio 0.76?0.04; amenorrheic for three years on average. Blood samples were taken for glycemia, cholesterol, HDL, LDL, FSH, LH, prolactin, estradiol, and progesterone measurement at 8 am, before and during the therapy with Trisequens. Hormone analysis: radioimmunoassay (PJA) (INEP, Zemun). Statistics: T-test and linear correlation. Results. Total cholesterol, HDL and LDL have decreased, while prolactin, estradiol and progesterone have increased significantly. Discussion. Women receiving hormone replacement therapy (HRT) have reported reduced mortality and morbidity (30% to 50%) and risk for coronary diseases (61%). Neither has Gaspard's study, nor has ours, found changes in concentrations of triglycerides due to higher synthesis of insulin and higher insulin sensitivity. However, 19-nortestosterone, in some studies, decreases HDL significantly. In our study, the decrease of HDL was not significant, because subjects were younger, with normal BMI. Women with PPOF have to start hormone therapy immediately, in order to prevent cardiovascular diseases, osteoporosis, depression, etc. and to improve their quality of life. .

Tibolone, oral or transdermal hormone replacement and colour Doppler analysis

OBJECTIVE

To compare the plasma thromboxane, the plasma viscosity and the Doppler flow modifications induced by tibolone and by oral or transdermal continuous combined hormone replacement therapy.

METHODS

Forty-two post-menopausal patients underwent either on: oral daily treatment with tibolone (2.5 mg) (Group I; n= 14); or continuous oral administration of 0.625 mg conjugated equine estrogens + medroxyprogesterone 5 mg per day (Group II; n = 14 ); or continuous estradiol transdermal supplementation, at a dose of 50 microg per day, + medroxyprogesterone 5 mg per day (Group III; n = 14 ). The duration of the study was 6 months and the patients were submitted to transvaginal ultrasonographic evaluation of pelvic organs; Doppler analysis of the uterine, internal carotid and ophthalmic arteries; thromboxane and plasma viscosity assays in basal condition, and at 1, 3 and 6 months from the beginning of the study.

RESULTS

Although the endometrial thickness increased significantly, there were no cases in which it exceeded the normal range (< or = 5 mm). In all the three groups, the pulsatility index of the uterine, internal carotid and ophthalmic arteries significantly decreased during the therapy showing a reduced impedance since the first month of treatment. Similar variations were observed for the peak systolic blood flow velocity of the internal carotid and ophthalmic arteries. Hormone replacement therapy and tibolone induced a deep, significant and rapid decrease in plasma thromboxane and plasma viscosity levels.

CONCLUSIONS

Hormone replacement therapy and tibolone seem to have beneficial effects on vascular and hemorrheological parameters.

Tools for making correct decisions regarding hormone therapy. part I: background and drugs

OBJECTIVE

To review existing scientific data related to the biology of estrogen in the aging process of women, and to understand the pharmacology, physiology, and diversity of sex hormones.

DESIGN

A MEDLINE computer search was performed to identify relevant articles.

RESULT(S)

Estrogen and progesterone have been prescribed for postmenopausal women over the last 60 years. Various formulations have had divergent properties, which are related to dissimilarities in the molecule structure, metabolism, plasma carrier, distribution, receptor binding, and the specific localizations of the different receptors in the various organs.

CONCLUSION(S)

Extensive data are available on the various characteristics of sex-hormone formulations, which are related to clinical consequences. The drugs and means of application have resulted in fundamental differences in activity, such as variance between oral and transdermal applications resulting in different forms of liver involvement. This information could assist in understanding why certain formulations may either prove harmful or beneficial to specific women.