Cardiovascular changes and cardiac morbidity of menopause. Effects of hormone replacement therapy

Abstract

The cessation of cyclic ovulation and consequent interruption of estrogen production by follicular cells in the ovaries is a natural phenomenon in women around 50 years of age, representing the menopause or climacterium. However, menopause can also result from surgical bilateral oophorectomy in a still fertile woman. Independently of its mechanism, menopause causes important metabolic and cardiovascular changes in women, as shown by several case-controlled and cohort studies. These changes do not seem to be due to differences in age or other factors, suggesting that the cause is the reduction in estrogen levels.During a woman's fertile years, coronary artery disease is rare, with a male-to-female ratio of at least 3:1, for age-matched individuals. After menopause, this ratio progressively decreases reaching 1:1, at the age of 75 and above 1 . A 50-year-old woman has a 50% chance of developing coronary artery disease, and a 30% chance of dying from it during the postmenopausal years 2 . For breast cancer, these ratios are 10% and 3%, and for endometrial cancer 3% and 0.3%, respectively.Thus, coronary artery disease is the major cause of death in adult woman (as it is for man) in developed countries. Although breast cancer is responsible for 43,000 deaths annually, and lung cancer for 51,000 deaths annually of women in the United States, coronary artery disease causes 236,000 annual deaths, and 87,000 strokes 2,3 . Even though there was a 20% reduction in mortality resulting from coronary artery disease in women from 1979 to 1989, the absolute number of women dying due to this pathology continues to increase. With the progressive increase in life expectancy, the number of women older than 50, and consequently in menopause, is much higher today than in previous decades. In the United States, the average life expectancy for women is around 80, showing not only a higher number of postmenopausal women but also that these women will live more than one third of their lives deprived of estrogen. Menopause and atherosclerotic diseaseFrom the pathologic point of view, atherosclerotic disease occurs later in women than in men, especially in the coronary arteries. Kayan et al. 4 determined that a 50-yearold woman has 45% of her aorta area and 25% of her coronary artery area affected by the atherosclerotic process, but a man of the same age has 50% and 40%, respectively. At 75 years of age, the figures are 75% of the aorta area and 55% of the coronary artery area for women and 70% and 55% for men, respectively. This shows that for postmenopausal women the speed of coronary atherosclerotic disease development is much higher than for men of the same age group, despite similar aortic involvement.These data support the Framingham Study, which showed that acute myocardial infarction -a clinical manifestation of coronary atherosclerosis -was rarely found in women before the age of 45, in a ratio of one woman to 40 men 5 . In the age group from 45 to 64 years, the number of infarctions in women was 45 times that of the younger group...

Effects of DHA-Rich n-3 Fatty Acid Supplementation and/or Resistance Training on Body Composition and Cardiometabolic Biomarkers in Overweight and Obese Post-Menopausal Women

“…Accordingly, a recent meta-analysis concluded that n-3 PUFA exert effects only in lowering TG [ 83 ]. These effects of DHA supplementation on cardiovascular risk factors are especially relevant in the postmenopausal population, in which cardiovascular-mortality exhibits a sudden rise [ 84 ].…”

Efeitos da terapia hormonal da menopausa sobre a gordura corporal

“…No que se refere às doenças cardiovasculares, durante a menacme, a incidência de cardiopatia isquêmica feminina é cerca de três vezes menor do que a masculina. Após a menopausa, o risco cardiovascular feminino aumenta progressivamente, equivalendo-se ao do homem aos 75 anos, 3 tornando-se a maior causa de óbito nestas mulheres. Os principais sinais e sintomas do climatério estão resumidos na tabela 1.…”

A Suplementação de isoflavona não potencializa os efeitos do exercício físico na redução da pressão arterial e sintomatologia climatérica: ensaio clínico, controlado, randomizado e duplo cego.

“…Os estrogênios têm ação moduladora sobre os neurotransmissores cerebrais, especialmente a serotonina, ligadas diretamente ao humor e outros sintomas neuropsíquicos (BRASIL, 2008), e atuam também na vasodilatação, local e sistêmica, pois há receptores de estrogênio nas paredes das artérias e quando estimulados, provocam vasodilatação (BASSAN, 1999). Além disso, os estrogênio apresenta importante função no controle cardiovascular através da modulação da função endotelial (WASSERTHEIL-SMOLLER et al, 2000) ao elevar a produção de óxido nítrico (NO) através de receptores específicos no endotélio vascular e de prostaciclina (PGI2), que são importantes substâncias vasodilatadoras dependentes de endotélio ZAROS, 2009).…”