© 2002 by European Society of Cardiology
Copyright © 2002, European Society of Cardiology
Hormones, genetic factors, and gender differences in cardiovascular disease
Women's Health Initiative, National Heart, Lung and Blood Institute, 1 Rockledge Center, Suite 300, 6705 Rockledge Drive, Bethesda, MD 20892-7966, USA
* Tel.: +1-301-435-6669; fax: +1-301-480-5158 rossouwj@nih.gov
Received 6 July 2001; accepted 30 August 2001
KEYWORDS Gender; Gene therapy
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1. Gender differences in age of onset of coronary heart disease |
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On average, women develop heart disease some 10–15 years later than men. This raises the question of whether there is some aspect of ‘femaleness’ which reduces risk, or whether there is some aspect of ‘maleness’ that raises risk. To date, most attention has been focused on the hypothesis that endogenous estrogen is cardioprotective in women [1]. Rising rates of coronary heart disease (CHD) after the menopause, and after oophorectomy, are among the strands of evidence in humans that endogenous estrogen may prevent CHD [2]. However, upon closer examination this evidence is not persuasive, and in fact the evidence is amenable to alternative explanations.
During the first 3 decades of adult life, low-density lipoprotein (LDL) cholesterol levels are lower in women than men, and this may contribute to the delayed onset of CHD in women. A more widely held explanation for the later onset of CHD in women is
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2. Observational studies of estrogen users |
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3. Biological mechanisms for cardioprotection by estrogen |
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4. Genetic mechanisms for cardioprotection by estrogen |
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5. Evidence of early harm from clinical trials |
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6. Mechanisms for explaining an increased risk for arterial disease shortly after commencing HRT |
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7. Conclusions |
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