Menopause and women’s cardiovascular health: is it really an obvious relationship?

Adach, Weronika; Ryczkowska, Kamila; Janikowski, Kamil; Banach, Maciej; Bielecka‐Dąbrowa, Agata

doi:10.5114/aoms/157308

Cited by 29 publications

(22 citation statements)

References 62 publications

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“…These data support the translation of dietary guidance and cardiovascular dietary guidelines for sustainable plant-based dietary patterns (1)(2)(3)(4)(5). The results of these data also support addressing the gender gap in CVD as this concern is of particular relevance to menopausal women given the fact that as the leading cause of death in women (22) which is underrecognized and undertreated (23,24), encouraging an increased intake of soy foods can reduce cardiovascular risk, as evident in health claims (14)(15)(16). The current ndings are also particularly relevant to menopausal women since soy foods have been shown to alleviate menopausal symptoms and up to 80% experience moderate-to-severe vasomotor symptoms, diminishing quality of life, and seek an alternative to hormone replacement therapy (HRT) due to its association with elevated cancer risk (25).…”

Section: Discussionmentioning

confidence: 62%

Effect of soy isoflavones on measures of estrogenicity: A systematic review and meta-analysis of randomized trials

Viscardi,

Back,

Ahmed

et al. 2024

Preprint

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Background Despite dietary recommendations to consume more plant foods for public and planetary health and the role that soy foods can play in plant-predominant diets, controversies around the effects of soy foods and their components, especially isoflavones, are a barrier to their intake. Given the cardioprotective effects and ability to alleviate menopausal symptoms, addressing this issue is particularly relevant to women. We therefore undertook a systematic review and meta-analysis of randomized controlled trials in postmenopausal women to determine the effect of soy isoflavones on measures of estrogenicity. Methods MEDLINE, Embase, and Cochrane Library were searched through July 2023 for randomized controlled trials 3-months investigating soy isoflavones versus non-isoflavone controls in postmenopausal women. The four outcomes included endometrial thickness (ET), vaginal maturation index (VMI), follicle-stimulating hormone (FSH), and estradiol. Independent authors extracted data and assessed risk of bias. GRADE (grading of recommendations assessment, development, and evaluation) was used to assess certainty of evidence. Results We included 40 trials (52 trial comparisons, n=3285) assessing the effect of a median daily dose of 75 mg of soy isoflavones in substitution for non-isoflavone control over a median of 24 weeks. Isoflavones had no statistically significant effects on any of the measures of estrogenicity; ET (mean difference, -0.22mm [95% confidence interval, -0.45 to 0.01mm], PMD=0.059), VMI (2.31 [-2.14 to 6.75], PMD=0.310), FSH (-0.02IU/L [-2.39 to 2.35IU/L], PMD=0.987), and estradiol (1.61pmol/L [-1.17 to 4.38pmol/L], PMD=0.256). The certainty of evidence was high-to-moderate for all outcomes. Conclusion Current evidence provides a good indication that soy isoflavones do not have an estrogenic effect versus non-isoflavone controls on 4 measures of estrogenicity in postmenopausal women. This synthesis supports the classification of soy isoflavones as selective estrogen receptor modulators and that isoflavones differ clinically from the hormone estrogen where no assumptions about the health effects of soy foods or isoflavones should be based on an understanding of the effects of the hormone estrogen. Addressing public health concerns around soy foods may support their intake as high-quality plant protein foods with low environmental impact and cost, especially relevant for postmenopausal women, and aligning with sustainable dietary patterns and guidelines. Registration: PROSPERO (CRD42023439239)

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Section: Discussionmentioning

confidence: 62%

Effect of soy isoflavones on measures of estrogenicity: A systematic review and meta-analysis of randomized trials

Viscardi,

Back,

Ahmed

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…We are well aware that sole usage of male animals represents a limitation of this study, since both MASLD and CVD feature gender specific differences, with women [19,42] and female mice [43,44] possessing a lower, oestrogen-dependent risk for these diseases compared to their male counterparts. However, we think that the higher risk for both diseases in males, the advantage of excluding a potentially confounding factor in the first cardiac assessment of this model in combination with the circumstance that there is still no established preclinical model for interorgan crosstalk in MASLD and CVD, legitimates this approach.…”

Section: Discussionmentioning

confidence: 99%

When the liver is in poor condition, so is the heart - cardiac remodelling in MASH mouse models

Bott,

Lallement,

Marino

et al. 2024

Preprint

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Metabolic dysfunction-associated steatohepatitis (MASH) confers a risk for cardiovascular diseases in patients. Animal models may help exploring the mechanisms linking liver and heart diseases. Hence, we explored the cardiac phenotype in MASH mouse models. Methods: We evaluated pathological alterations in liver and heart in foz/foz mice fed a high fat diet for 24 or 60 weeks and in C57BL/6J mice fed a high fat, high fructose diet for 60 weeks. Angiotensin II (AngII) was used as an additional cardiovascular stressor. Results: Foz/foz mice with fibrosing MASH developed cardiac hypertrophy with adverse cardiac remodelling not seen in WT similarly fed the high fat diet. AngII caused hypertension and upregulated the expression of genes contributing to pathological cardiac hypertrophy (Nppa, Myh7) more severely so in foz/foz mice than in controls. After 60 weeks of HFD, while liver disease had progressed to burn-out non steatotic MASH with hepatocellular carcinoma in 50% of the animals, the cardiomyopathy did not. In an independent model (C57BL/6J mice fed a high fat, high fructose diet), moderate fibrosing MASH is associated with cardiac fibrosis and dysregulation of genes involved in pathological remodelling (Col1a1, Col3a1, Vim, Myh6, Slc2a1). Conclusion: Animals with MASH present consistent adverse structural changes in the heart with no patent alteration of cardiac function even when stressed with exogenous AngII. Liver disease, and not overfeeding or aging alone, is associated with this cardiac phenotype. Our findings confirm foz/foz mice as suitable for studying links between MASH and heart structural changes ahead of heart failure.

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“…Previous studies have shown disruptions in the cyclic pattern of circulating estrogen, a potent anti-inflammatory agent, [76] during the menopausal shift. This activates broader innate and adaptive immune reactions in the body [77], elevating levels of chronic systemic inflammation [78], increasing the risk of cardiovascular diseases [79] and making the brain more susceptible to ischemic damage. This highlights the potential complex interplay of monocyte subtypes in the context of aging.…”

Section: Discussionmentioning

confidence: 99%

Human monocyte subtype expression of neuroinflammation and regeneration-related genes is linked to age and sex

Tampé,

Monni,

Palma-Tortosa

et al. 2024

Preprint

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Stroke is a leading cause of disability and the third cause of death. The immune system plays a pivotal role in post-stroke recovery. After an ischemic stroke, monocytes infiltrate the injured brain tissue and can exacerbate or mitigate the damage. There are sex disparities in ischemic stroke incidence, outcomes, and recovery, and these differences may be hormone-driven and/or determined by genetic and epigenetic factors. Ischemic stroke is more prevalent in the aged population, and the aged brain exhibits an altered immune response. Here, we studied whether peripheral blood human monocyte sub-type (classical, intermediate, and non-classical) expression of inflammation- and regeneration-related genes depends on age and sex. FACS analysis of blood samples from 44 healthy volunteers showed that the numbers of B-cells, NK-cells, T-cells, monocytes, and subtypes of monocytes were not linked to age or sex. Gene expression analysis by qPCR identified several genes differentially correlating with age and sex within different monocyte subtypes. Interestingly, ANXA1 and CD91 showed a consistent increase with aging in all monocyte subtypes and in non-classical and intermediate, respectively. Most age-dependent genes were differentially expressed in females. Our findings show that the gene expression pattern in monocyte subtypes is correlated with age and sex. This may have implications for the characteristics and role of the immune response during the stroke and its contribution to the recovery. Our data might help to understand the role of monocytes in stroke better and support the development of new neuroinflammation modulation-based treatments for stroke patients.

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Menopause and women’s cardiovascular health: is it really an obvious relationship?

Cited by 29 publications

References 62 publications

Effect of soy isoflavones on measures of estrogenicity: A systematic review and meta-analysis of randomized trials

Effect of soy isoflavones on measures of estrogenicity: A systematic review and meta-analysis of randomized trials

When the liver is in poor condition, so is the heart - cardiac remodelling in MASH mouse models

Human monocyte subtype expression of neuroinflammation and regeneration-related genes is linked to age and sex

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