1
|
Gersh FL, O'Keefe JH, Lavie CJ. Postmenopausal hormone therapy for cardiovascular health: the evolving data. Heart 2021; 107:1115-1122. [PMID: 33619206 DOI: 10.1136/heartjnl-2019-316323] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 01/26/2023] Open
Abstract
Postmenopausal (PM) hormone therapy (HT) was extremely popular for years as a treatment for many conditions, including cardiovascular (CV) disease (CVD) prevention. The adverse results from the Women's Health Initiative (WHI) ended the widespread prescriptive use of HT for nearly 20 years. The WHI findings have been broadly and unfairly applied to all hormone formulations, including modern treatments using human-identical hormones. Although CV health is indisputably linked to oestrogen status, HT involving any combination of hormones currently is not recommended for primary or secondary prevention of CVD. In the wake of more positive results from recent studies and re-evaluation of the WHI, HT has re-emerged as an issue for specialists in CVD to discuss with their patients. Rigorous scientific analysis is needed to explain the paradox of cardioprotection conferred by endogenous ovarian hormones with apparent cardiotoxicity inflicted by HT. This review will cover the origins of HT, hormone terminology and function, and key studies that contribute to our current understanding. Based on evolving evidence, if HT is to be used, we propose it be initiated immediately after cessation of ovarian hormone production and dosed as transdermal oestradiol combined with cyclic dosing of human-identical progesterone (P4).
Collapse
Affiliation(s)
- Felice L Gersh
- Internal Medicine, Fellowship in Integrative Medicine, University of Arizona College of Medicine, Irvine, California, USA
| | - James H O'Keefe
- University of Missouri-Kansas City, Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Carl J Lavie
- Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, Louisiana, USA
| |
Collapse
|
2
|
Brianezi L, Ornelas E, Gehrke FDS, Fonseca FLA, Alves BDCA, Sousa LVDA, Souza J, Maifrino LBM. Effects of Physical Training on the Myocardium of Oxariectomized LDLr Knockout Mice: MMP 2/9, Collagen I/III, Inflammation and Oxidative Stress. Arq Bras Cardiol 2020; 114:100-105. [PMID: 31644698 PMCID: PMC7025313 DOI: 10.5935/abc.20190223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/30/2019] [Accepted: 03/10/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The emergence of coronary heart disease is increased with menopause, physical inactivity and with dyslipidemia. Physical training is known to promote the improvement of cardiovascular functions. OBJECTIVE To investigate the effects of aerobic physical training on the left ventricle in ovariectomized LDL knockout mice. METHODS Thirty animals were divided into 6 groups (n = 5): Sedentary non-ovariectomized control; Sedentary ovariectomized control; Trained ovariectomized control; Sedentary non-ovariectomized LDL-knockout, sedentary ovariectomized LDL-knockout and trained ovariectomized LDL-knockout. We analyzed the average parameters of apparent density of collagen fibers types I and III, and metalloproteinase type 2 and type 9, were considered significant p < 0.05. RESULTS The results showed that the proposed exercise protocol altered the volume of type I collagen fibers, altered collagen remodeling parameters (MMP-2), and also reduced the 8-hydroxy-2'-deoxyguanosine (8OHdG) oxidative stress parameter. CONCLUSION Moderate intensity aerobic training acts on collagen fiber volume, on collagen remodeling with the reduction of oxidative stress in the left ventricles of ovariectomized LDL-knockout mice.
Collapse
Affiliation(s)
- Ledimar Brianezi
- Laboratório de Estudos Morfoquantitativo e Imunohistoquímico, Universidade São Judas Tadeu, São Paulo, SP - Brazil
| | - Elisabete Ornelas
- Laboratório de Estudos Morfoquantitativo e Imunohistoquímico, Universidade São Judas Tadeu, São Paulo, SP - Brazil
| | - Flávia de Sousa Gehrke
- Departamento de Farmácia, Universidade Paulista, São Paulo, SP - Brazil
- Pós-Graduação em Ciências da Saúde, Hospital do Servidor Público Estadual, São Paulo, SP - Brazil
- Laboratório de Análises Clínicas da Faculdade de Medicina do ABC, Santo André, SP - Brazil
| | - Fernando Luiz Affonso Fonseca
- Laboratório de Análises Clínicas da Faculdade de Medicina do ABC, Santo André, SP - Brazil
- Departamento de Ciências Farmacêuticas da Universidade Federal de São Paulo, Diadema, SP - Brazil
| | | | | | - Jessica Souza
- Laboratório de Estudos Morfoquantitativo e Imunohistoquímico, Universidade São Judas Tadeu, São Paulo, SP - Brazil
| | | |
Collapse
|
3
|
Brianezi L, Marques MR, Cardoso CG, Miranda MLDJ, Fonseca FLA, Maifrino LBM. EFFECTS OF PHYSICAL TRAINING ON THE MYOCARDIUM OF FEMALE LDL KNOCKOUT OVARIECTOMIZED MICE. REV BRAS MED ESPORTE 2017. [DOI: 10.1590/1517-869220172306160084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: The emergence of coronary heart disease increases with menopause, physical inactivity and with dyslipidemia. It is known that physical training promotes the improvement of cardiovascular functions. Objective: The purpose of this study was to investigate the effects of aerobic physical training on the left ventricle in female LDL knockout ovariectomized mice. Methods: Thirty animals were divided into 6 groups (n=5), namely, sedentary non-ovariectomized control; sedentary ovariectomized control; trained ovariectomized control; sedentary non-ovariectomized; sedentary ovariectomized; and trained ovariectomized. We analyzed the mean nuclear volume parameters, the cross sectional area of the myocytes, the apparent density of the capillaries, interstitium, myocytes and collagen fibers. Results: The results show that for the density of the number of nuclei, the physical activity decreased to values close to the ovariectomized control group. Regarding the mean nuclear volume and the average area of myocytes, training and ovariectomy promoted the elevation of these values but hypercholesterolemia was lower. the volume density of myocytes, hypercholesterolemia showed an increase of these values as well as the training. There was no change in the volumetric density of the capillaries and the density of collagen fibers. The training caused the decrease in the density of the interstitial volume, and the hypercholesterolemia changed to a smaller one than the control group. Conclusion: We concluded that the moderate aerobic activity or the training time used in our study were not sufficient to generate significant alterations in the hypercholesterolemic group.
Collapse
Affiliation(s)
- Ledimar Brianezi
- Universidade São Judas Tadeu, Brazil; Faculdade Adventista de Hortolândia (UNASP), Brazil
| | | | | | | | | | | |
Collapse
|
4
|
Fidarov AF, Vihma V, Bogautdinov RP, Morozkina SN, Shavva AG, Tikkanen MJ. Novel structural features increase the antioxidant effect of estrogen analogues on low density lipoprotein. J Steroid Biochem Mol Biol 2015; 154:142-9. [PMID: 26255276 DOI: 10.1016/j.jsbmb.2015.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 07/01/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
Many known estrogens, both natural and synthetic, may act as antioxidants. We designed and synthesized 22 novel estrogen analogues with different ring junctions or substitutions, such as fluorine. We studied the antioxidant capacity in vitro of 35 synthetic estrogen analogues in aqueous lipoprotein solution by monitoring the formation of conjugated dienes. In addition to a free C-3 hydroxyl group, the two most active antioxidants had either a methyl group at C-4 and a six-carbon D-ring, or a fluorine atom at C-2 and an unsaturated B-ring. Extension of the D-ring increased the antioxidant capacity of 6-oxa estrogens. Compounds with a fluorine atom at C-2 were similar or more potent antioxidants compared with the principal endogenous estrogen, 17β-estradiol. In compounds with a substituted C-3 hydroxyl group, the antioxidant capacity could be significantly increased by additional double bonds in the C- or D-rings. In conclusion, we show that the antioxidant capacity of estrogen analogues could be increased by structural changes.
Collapse
Affiliation(s)
- Alan F Fidarov
- Department of Natural Compounds Chemistry, Faculty of Chemistry, St. Petersburg State University, Universitetskii pr. 26, Petrodvorets, 198504 St. Petersburg, Russia
| | - Veera Vihma
- Folkhälsan Research Center, Haartmaninkatu 8, Helsinki, 00290, Finland; University of Helsinki and Helsinki University Central Hospital, Heart and Lung Center, Haartmaninkatu 8, 00290 Helsinki, Finland.
| | - Roman P Bogautdinov
- Department of Natural Compounds Chemistry, Faculty of Chemistry, St. Petersburg State University, Universitetskii pr. 26, Petrodvorets, 198504 St. Petersburg, Russia
| | - Svetlana N Morozkina
- Department of Natural Compounds Chemistry, Faculty of Chemistry, St. Petersburg State University, Universitetskii pr. 26, Petrodvorets, 198504 St. Petersburg, Russia
| | - Alexander G Shavva
- Department of Natural Compounds Chemistry, Faculty of Chemistry, St. Petersburg State University, Universitetskii pr. 26, Petrodvorets, 198504 St. Petersburg, Russia
| | - Matti J Tikkanen
- Folkhälsan Research Center, Haartmaninkatu 8, Helsinki, 00290, Finland; University of Helsinki and Helsinki University Central Hospital, Heart and Lung Center, Haartmaninkatu 8, 00290 Helsinki, Finland
| |
Collapse
|
5
|
Mattison DR, Karyakina N, Goodman M, LaKind JS. Pharmaco- and toxicokinetics of selected exogenous and endogenous estrogens: A review of the data and identification of knowledge gaps. Crit Rev Toxicol 2014; 44:696-724. [DOI: 10.3109/10408444.2014.930813] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
6
|
Bhavnani BR, Stanczyk FZ. Pharmacology of conjugated equine estrogens: efficacy, safety and mechanism of action. J Steroid Biochem Mol Biol 2014; 142:16-29. [PMID: 24176763 DOI: 10.1016/j.jsbmb.2013.10.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 10/10/2013] [Accepted: 10/17/2013] [Indexed: 12/12/2022]
Abstract
Oral conjugated equine estrogens (CEE) are the most used estrogen formulation for postmenopausal hormone therapy either alone or in combination with a progestin. CEE is most commonly used for the management of early menopausal symptoms such as hot flashes, vaginitis, insomnia, and mood disturbances. Additionally, if used at the start of the menopausal phase (age 50-59 years), CEE prevents osteoporosis and may in some women reduce the risk of cardiovascular disease (CVD) and Alzheimer's disease (AD). There appears to be a common mechanism through which estrogens can protect against CVD and AD. CEE is a natural formulation of an extract prepared from pregnant mares' urine. The product monogram lists the presence of only 10 estrogens consisting of the classical estrogens, estrone and 17β-estradiol, and a group of unique ring B unsaturated estrogens such as equilin and equilenin. The ring B unsaturated estrogens are formed by an alternate steroidogenic pathway in which cholesterol is not an obligatory intermediate. Both the route of administration and structure of these estrogens play a role in the overall pharmacology of CEE. In contrast to 17β-estradiol, ring B unsaturated estrogens express their biological effects mainly mediated by the estrogen receptor β and not the estrogen receptor α. All estrogen components of CEE are antioxidants, and some ring B unsaturated estrogens have several fold greater antioxidant activity than estrone and 17β-estradiol. The cardioprotective and neuroprotective effects of CEE appear to be, to some extent, due to its ability to prevent the formation of oxidized LDL and HDL, and by inhibiting or modulating some of the key proteases involved in programmed cell death (apoptosis) induced by the excess neurotransmitter glutamate and other neurotoxins. Selective combinations of ring B unsaturated estrogens have the potential of being developed as novel therapeutic agents for the prevention of cardiovascular disease and Alzheimer's disease in both aging women and men. This article is part of a Special Issue entitled 'Menopause'.
Collapse
Affiliation(s)
- Bhagu R Bhavnani
- Department of Obstetrics and Gynecology, University of Toronto and The Keenan Research Center of Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada M5B 1W8.
| | - Frank Z Stanczyk
- Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, United States; Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, United States
| |
Collapse
|
7
|
Badeau M, Adlercreutz H, Kaihovaara P, Tikkanen MJ. Estrogen A-ring structure and antioxidative effect on lipoproteins. J Steroid Biochem Mol Biol 2005; 96:271-8. [PMID: 15993048 DOI: 10.1016/j.jsbmb.2005.04.034] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Accepted: 04/04/2005] [Indexed: 01/11/2023]
Abstract
The oxidative modification of lipoprotein particles is an important step in atherogenesis. Estrogens are known to be powerful antioxidants independently of their binding to the estrogen receptors and the hormonal functions. We explored the structural determinants for the antioxidant activity of a large number of estrogen derivatives (n=43) in an aqueous lipoprotein solution in vitro by monitoring formation of conjugated dienes. Our results indicate that estrogen derivatives with an unsubstituted A-ring phenolic hydroxyl group with one or two adjacent methoxy groups provide strongest antioxidant protection of low density lipoprotein (LDL) and high density lipoprotein (HDL). The electron donating methoxy groups may enhance the antioxidant effect by weakening the phenolic OH bond and providing stability to the formed phenoxyl radical. With some exceptions, compounds completely lacking unsubstituted hydroxyl groups in the A-ring exhibited no antioxidant effect, e.g. the most hydrophilic "tetrol" compound with three unsubstituted A-ring hydroxyl groups had no antioxidant effect. Moreover, additional hydroxyl groups in the B-, C- or D-ring seemed to weaken the antioxidant effect. Accordingly, both the presence of unsubstituted hydroxyl groups and adjacent substituents, as well as the lipophilicity of the derivatives determine the antioxidant activity of estrogen derivatives in aqueous lipoprotein solutions.
Collapse
Affiliation(s)
- Maija Badeau
- Department of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | | | | | | |
Collapse
|
8
|
Perrella J, Bhavnani BR. Protection of cortical cells by equine estrogens against glutamate-induced excitotoxicity is mediated through a calcium independent mechanism. BMC Neurosci 2005; 6:34. [PMID: 15882473 PMCID: PMC1142325 DOI: 10.1186/1471-2202-6-34] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2004] [Accepted: 05/10/2005] [Indexed: 12/20/2022] Open
Abstract
Background High concentrations of glutamate can accumulate in the brain and may be involved in the pathogenesis of neurodegenerative disorders such as Alzheimer's disease. This form of neurotoxicity involves changes in the regulation of cellular calcium (Ca2+) and generation of free radicals such as peroxynitrite (ONOO-). Estrogen may protect against glutamate-induced cell death by reducing the excitotoxic Ca2+ influx associated with glutamate excitotoxicity. In this study, the inhibition of N-methyl-D-aspartate (NMDA) receptor and nitric oxide synthase (NOS) along with the effect of 17β-estradiol (17β-E2) and a more potent antioxidant Δ8, 17β-estradiol (Δ8, 17β-E2) on cell viability and intracellular Ca2+ ([Ca2+]i), following treatment of rat cortical cells with glutamate, was investigated. Results Primary rat cortical cells were cultured for 7–12 days in Neurobasal medium containing B27 supplements. Addition of glutamate (200 μM) decreased cell viability to 51.3 ± 0.7% compared to control. Treatment with the noncompetitive NMDAR antagonist, MK-801, and the NOS inhibitor, L-NAME, completely prevented cell death. Pretreatment (24 hrs) with 17β-E2 and Δ8, 17β-E2 (0.01 to 10 μM) significantly reduced cell death. 17β-E2 was more potent than Δ8, 17β-E2. Glutamate caused a rapid 2.5 fold increase in [Ca2+]i. Treatment with 0.001 to 10 μM MK-801 reduced the initial Ca2+ influx by 14–41% and increased cell viability significantly. Pretreatment with 17β-E2 and Δ8, 17β-E2 had no effect on Ca2+ influx but protected the cortical cells against glutamate-induced cell death. Conclusion Glutamate-induced cell death in cortical cultures can occur through NMDAR and NOS-linked mechanisms by increasing nitric oxide and ONOO-. Equine estrogens: 17β-E2 and Δ8, 17β-E2, significantly protected cortical cells against glutamate-induced excitotoxicity by a mechanism that appears to be independent of Ca2+ influx. To our knowledge, this is a first such observation. Whether the decrease in NOS related products such as ONOO-, is a mechanism by which estrogens protect against glutamate toxicity, remains to be investigated. Estrogen replacement therapy in healthy and young postmenopausal women may protect against neurodegenerative diseases by these mechanisms.
Collapse
Affiliation(s)
- Joel Perrella
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Canada
| | - Bhagu R Bhavnani
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Canada
| |
Collapse
|
9
|
Abstract
BACKGROUND Although estrogen has been clinically available for more than 6 decades, women have been confused by different opinions regarding the risks and benefits of menopausal hormone therapy (HT), estrogen therapy (ET), and estrogen-progestin therapy (EPT). The publication of recent randomized controlled trials (RCTs), notably, the Heart and Estrogen Replacement Study (HERS), Women's Health Initiative (WHI), and Women's Health Initiative Memory Study (WHIMS), has intensified the risk versus benefit controversy and prompted this review. OBJECTIVE We provide a systematic, comprehensive, and critical review of selected literature that addresses the basic and clinical aspects of menopausal HT. RESULTS Solid, consistent evidence based on observational, epidemiologic, and randomized controlled trials underpins the efficacy of menopausal HT for its regulatory agency-approved indications: vasomotor symptoms, vulvovaginal atrophy symptoms, and osteoporosis-related fracture prevention. ET and EPT increase the risk for venous thromboembolism, although the absolute number of events and the risk are both small. Though there is a small increase in the number of breast cancers in women who have used menopausal HT for more than 10 years, the biological meaning of this observation (cause versus unmasking versus chance) is unresolved. Most evidence shows that menopausal HT does not affect breast cancer recurrence and that overall longevity is higher in breast cancer survivors who select menopausal HT. Strong basic science and clinical observational evidence show a benefit of menopausal HT in the cardiovascular and central nervous systems. Data from recent RCTs that included predominantly overweight women aged between 63 and 71 years have been reported to show more harm than benefit; the rush to generalize these studies to all women and all menopausal HT regimens is unjustified. CONCLUSION Menopausal HT improves vasomotor symptoms and vulvovaginal atrophy symptoms and prevents osteoporosis-related fracture. Menopausal HT increases the likelihood of venous thromboembolism, but other harms such as breast cancer require further controlled studies. A clinical benefit of menopausal HT for cardiovascular or central nervous system disease prevention is unproven. RCTs of menopausal HT in newly menopausal women, or in women less than 3 years from menopause, are urgently needed to investigate the prevention of cardiovascular and central nervous system aging diseases.
Collapse
Affiliation(s)
- Bhagu R Bhavnani
- Department of Obstetrics and Gynecology, University of Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | | |
Collapse
|
10
|
Wang JF, Guo YX, Niu JZ, Liu J, Wang LQ, Li PH. Effects of Radix Puerariae flavones on liver lipid metabolism in ovariectomized rats. World J Gastroenterol 2004; 10:1967-70. [PMID: 15222048 PMCID: PMC4572242 DOI: 10.3748/wjg.v10.i13.1967] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To study the effects of Radix Puerariae flavones (RPF) on liver lipid metabolism in ovariectomized (OVX) rats.
METHODS: Forty adult female Wistar rats were randomly divided into four groups: OVX group; sham-OVX group; OVX + estrogen group and OVX + RPF group. One week after operation rats of the first two groups were treated with physiological saline, rats of OVX + estrogen group with estrogen (1 mg/kg·b.w.) and rats of OVX + RPF group with RPF (100 mg/kg·b.w.), respectively for 5 weeks. After the rats were killed, their body weight, the weight of the abdominal fat and uterus were measured, and the levels of total cholesterol (TC) and triglyceride (TG) in liver homogenate were determined.
RESULTS: Compared with the sham-OVX group, the body mass of the rats in OVX group was found increased significantly; more abdominal fat in store; TC and TG in liver increased and uterine became further atrophy. As a result, the RPF was found to have an inhibitive action on those changes of various degrees.
CONCLUSION: RPF has estrogen-like effect on lipid metabolism in liver and adipose tissue.
Collapse
Affiliation(s)
- Ji-Feng Wang
- Department of Biochemistry, Beijing University of Chinese Medicine, Beijing 100029, China
| | | | | | | | | | | |
Collapse
|