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Cardiovascular Research 2002 53(3):605-619; doi:10.1016/S0008-6363(01)00466-7
© 2002 by European Society of Cardiology
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Copyright © 2002, European Society of Cardiology

Estrogen replacement therapy, atherosclerosis, and vascular function

Tomi S Mikkolaa,b and Thomas B Clarksona,*

aComparative Medicine Clinical Research Center, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1040, USA
bDepartment of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki 00290, Finland

tclarkso{at}wfubmc.edu

* Corresponding author. Tel.: +1-336-716-1570; fax: +1-336-716-1601

There is strong evidence from both human and nonhuman primate studies supporting the conclusion that estrogen deficiency increases the progression of atherosclerosis. More controversial is the conclusion that postmenopausal estrogen replacement inhibits the progression of atherosclerosis. Estrogen treatment of older women (>65 years) with pre-existing coronary artery atherosclerosis had no beneficial effects. In contrast, estrogen treatment of younger postmenopausal women or monkeys in the early stages of atherosclerosis progression has marked beneficial effects. Whether progestogens attenuate the cardiovascular benefits of estrogen replacement therapy has been controversial for more than a decade. Current evidence from studies of both monkeys and women suggest little or no attenuation of estrogen benefits for coronary artery atherosclerosis. Lack of compliance with estrogen replacement therapy, usually because of fear of breast cancer, remains a major problem. Future regimens may overcome that fear by the co-administration of a breast cancer preventive agent (i.e., selective estrogen receptor modulators, phytoestrogens) with low dose estrogen.

KEYWORDS Atherosclerosis; Endothelial function; Hormones; Infection/inflammation; Lipid metabolism


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