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Menopause is associated with changes consistent with cardiovascular aging. The effects on cardiac disease is
multifaceted affecting endothelial function, coronary artery physiology and metabolic dysfunction leading to structural
changes in the coronary anatomy. A systematic review of literature from 1986 to 2019 was conducted using PubMed and
Google Scholar. The search was directed to retrieve papers that addressed the changes in cardiovascular physiology in
menopause and the current therapies available to treat cardiovascular manifestations of menopause. The metabolic and
clinical factors secondary to menopause such as dyslipidemia, insulin resistance, fat redistribution and systemic
hypertension contribute to the accelerated risk for cardiovascular aging and disease. Atherosclerosis appears to be the end
result of the interaction between cardiovascular risk factors and their accentuation during the perimenopausal period.
Additionally, complex interactions between oxidative stress and levels of L-arginine and ADMA may also influence
endothelial dysfunction in menopause. The increased cardiovascular risk in menopause stems from the exaggerated effects
of changing physiology on the cardiovascular system affecting peripheral, cardiac and cerebrovascular beds. The
differential effects of menopause on cardiovascular disease at the subclinical, biochemical and molecular levels form the
highlights of this review.
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