Estradiol Levels Are Decreased in Premenopausal Women with Coronary Heart Disease

Hanke, Hartmut; Hanke, Sybille; Mick, Al-fred O.; Ickrath, O; Lange, Kathrin; Bruck, Birgit; Voisard, Rainer; Seeger, Harald; Zwirner, M.; Both, A; Haasis, R; Hombach, Vinzenz

doi:10.1097/00042192-199502040-00045

Cited by 13 publications

(16 citation statements)

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“…177 The possibility that these observations might reflect the reduced concentrations of endogenous estrogen characteristic of ovary-impaired women is supported by the finding that premenopausal women with angiographically confirmed CAD have significantly lower plasma estradiol concentrations than do control subjects and that such levels resemble those observed in subordinate female monkeys. 173,178 Notably, many premenopausal women may experience ovarian compromise at some time during their reproductive years. 179 The general term for this compromise is functional hypothalamic hypogonadism, the manifestations of which range from subclinical luteal-phase defects with regular menstrual intervals to irregular cycles to amenorrhea.…”

Section: Sex Differencesmentioning

confidence: 99%

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

1999

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Abstract-Recent studies provide clear and convincing evidence that psychosocial factors contribute significantly to the pathogenesis and expression of coronary artery disease (CAD). This evidence is composed largely of data relating CAD risk to 5 specific psychosocial domains: (1) depression, (2) anxiety, (3) personality factors and character traits, (4) social isolation, and (5) chronic life stress. Pathophysiological mechanisms underlying the relationship between these entities and CAD can be divided into behavioral mechanisms, whereby psychosocial conditions contribute to a higher frequency of adverse health behaviors, such as poor diet and smoking, and direct pathophysiological mechanisms, such as neuroendocrine and platelet activation. An extensive body of evidence from animal models (especially the cynomolgus monkey, Macaca fascicularis) reveals that chronic psychosocial stress can lead, probably via a mechanism involving excessive sympathetic nervous system activation, to exacerbation of coronary artery atherosclerosis as well as to transient endothelial dysfunction and even necrosis. Evidence from monkeys also indicates that psychosocial stress reliably induces ovarian dysfunction, hypercortisolemia, and excessive adrenergic activation in premenopausal females, leading to accelerated atherosclerosis.Also reviewed are data relating CAD to acute stress and individual differences in sympathetic nervous system responsivity. New technologies and research from animal models demonstrate that acute stress triggers myocardial ischemia, promotes arrhythmogenesis, stimulates platelet function, and increases blood viscosity through hemoconcentration. In the presence of underlying atherosclerosis (eg, in CAD patients), acute stress also causes coronary vasoconstriction. Recent data indicate that the foregoing effects result, at least in part, from the endothelial dysfunction and injury induced by acute stress. Hyperresponsivity of the sympathetic nervous system, manifested by exaggerated heart rate and blood pressure responses to psychological stimuli, is an intrinsic characteristic among some individuals. Current data link sympathetic nervous system hyperresponsivity to accelerated development of carotid atherosclerosis in human subjects and to exacerbated coronary and carotid atherosclerosis in monkeys.Thus far, intervention trials designed to reduce psychosocial stress have been limited in size and number. Specific suggestions to improve the assessment of behavioral interventions include more complete delineation of the physiological mechanisms by which such interventions might work; increased use of new, more convenient "alternative" end points for behavioral intervention trials; development of specifically targeted behavioral interventions (based on profiling of patient factors); and evaluation of previously developed models of predicting behavioral change. The importance of maximizing the efficacy of behavioral interventions is underscored by the recognition that psychosocial stresses tend to cluster together. ...

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Section: Sex Differencesmentioning

confidence: 99%

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

1999

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“…It is admitted that ovarian hormones protect premenopausal women from CVR and that endogenous E reduction accelerates CVD. Thus, premenopausal women with angiographically confirmed coronary disease have significantly lower plasma E 2 than controls (130). The Women's Ischemia Syndrome Evaluation (WISE) study assessed female ischemic heart disease pathophysiology and how sex hormones and other gender-specific findings influence clinical aspects of the disease.…”

Section: Stress and Psychosocial Factorsmentioning

confidence: 99%

Cardiovascular risk in menopausal women and prevalent related co-morbid conditions: facing the post-Women's Health Initiative era

Pérez‐López

Chedraui

Gilbert

et al. 2009

Fertility and Sterility

131

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“…The second study compared 14 women who had confirmed CHD with 14 controls who had not been subjected to angiography (Hanke et al 1997). Again, the women with CHD were estrogen deficient relative to controls, leading the investigators to suggest that decreased circulating estrogen increases risk of cardiovascular disease in premenopausal women.…”

Section: Public Health Implicationsmentioning

confidence: 99%

“…Epidemiological and autopsy studies reveal that the underlying atherosclerosis likely originates during the premenopausal years (Strong et al 1978(Strong et al , 1999Sutton-Tyrrell et al 1998;Tuzco et al 2001). Notably, two clinical studies provide evidence that functional reproductive deficits and associated estrogen deficiency contribute to the premenopausal development of disease (Bairey Merz et al 2003b;Hanke et al 1997), and a third study indicates that premenopausal OC exposure reduces the severity of postmenopausal coronary disease (Bairey Merz et al 2003a).…”

Section: Contribution Of Functional Reproductive Deficits To the Devementioning

confidence: 99%

Ovarian Dysfunction, Stress, and Disease: A Primate Continuum

Kaplan¹,

Manuck²

2004

ILAR Journal

119

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Menopause is recognized as a period of increased risk for coronary heart disease (CHD) and osteoporosis. Vulnerability to these conditions is often attributed to the naturally occurring estrogen deficiency characteristic of this part of the life cycle. Premenopausal reductions in endogenous estrogen occasioned by functional ovarian abnormalities or failure are hypothesized to be similarly pathogenic and to accelerate development of CHD and osteoporosis prematurely, thereby increasing the health burden of older women. These functional abnormalities, which occur along a continuum from mild, luteal phase progesterone deficiency to amenorrhea, are relatively common and are often attributed to psychogenic factors (stress, anxiety, depression, or other emotional disturbance), exercise, or energy imbalance. Although numerous investigators have commented on these functional deficits, the abnormalities can be difficult to diagnose and are generally unappreciated for the contribution they may make to postmenopausal disease. Studies in nonhuman primates confirm that these deficits are easily induced by psychological stress and exercise, and that they accelerate the development of cardiovascular disease and perhaps bone loss in the presence of a typical North American diet. However, functional reproductive deficits are also reversible and are thus potentially amenable to environmental or behavioral intervention. Data from both women and nonhuman primates support the hypothesis that functional reproductive deficits are adaptive when triggered appropriately but are detrimental when activated in an environment (e.g., sedentary lifestyle, high-fat diet) permissive to the development of chronic disease.

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Estradiol Levels Are Decreased in Premenopausal Women with Coronary Heart Disease

Cited by 13 publications

References 0 publications

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

Impact of Psychological Factors on the Pathogenesis of Cardiovascular Disease and Implications for Therapy

Cardiovascular risk in menopausal women and prevalent related co-morbid conditions: facing the post-Women's Health Initiative era

Ovarian Dysfunction, Stress, and Disease: A Primate Continuum

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