Department of Medicine, University of Padova, Padova, Italy.
Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy.
Steroids. 2024 Jun;206:109423. doi: 10.1016/j.steroids.2024.109423. Epub 2024 Apr 16.
There are considerable sex differences regarding the risk of cardiovascular disease (CVD), including arterial hypertension, coronary artery disease (CAD) and stroke, as well as chronic renal disease. Women are largely protected from these conditions prior to menopause, and the risk increases following cessation of endogenous estrogen production or after surgical menopause. Cardiovascular diseases in women generally begin to occur at a later age than in men (on average with a delay of 10 years). Cessation of estrogen production also impacts metabolism, increasing the risk of developing obesity and diabetes. In middle-aged individuals, hypertension develops earlier and faster in women than in men, and smoking increases cardiovascular risk to a greater degree in women than it does in men. It is not only estrogen that affects female cardiovascular health and plays a protective role until menopause: other sex hormones such as progesterone and androgen hormones generate a complex balance that differentiates heart and blood vessel function in women compared to men. Estrogens improve vasodilation of epicardial coronary arteries and the coronary microvasculature by augmenting the release of vasodilating factors such as nitric oxide and prostacyclin, which are mechanisms of coronary vasodilatation that are more pronounced in women compared to men. Estrogens are also powerful inhibitors of inflammation, which in part explains their protective effects on CVD and chronic renal disease. Emerging evidence suggests that sex chromosomes also play a significant role in shaping cardiovascular risk. The cardiovascular protection conferred by endogenous estrogens may be extended by hormone therapy, especially using bioidentical hormones and starting treatment early after menopause.
在心血管疾病（CVD）风险方面，存在相当大的性别差异，包括动脉高血压、冠心病（CAD）和中风以及慢性肾病。女性在绝经前在很大程度上免受这些疾病的影响，而在雌激素内源性产生停止或手术绝经后，风险会增加。女性的心血管疾病一般比男性晚（平均延迟 10 年）开始发生。雌激素的产生停止也会影响新陈代谢，增加肥胖和糖尿病的发病风险。在中年人群中，女性的高血压比男性更早、更快地发展，吸烟对女性的心血管风险的影响程度大于男性。影响女性心血管健康并在绝经前发挥保护作用的不仅是雌激素：其他性激素，如孕激素和雄激素，会产生一种复杂的平衡，使女性的心脏和血管功能与男性不同。雌激素通过增加血管扩张因子的释放（如一氧化氮和前列环素）来改善心外膜冠状动脉和冠状动脉微血管的扩张，这些是女性比男性更明显的冠状动脉扩张机制。雌激素也是炎症的强大抑制剂，这部分解释了它们对 CVD 和慢性肾病的保护作用。新出现的证据表明，性染色体在塑造心血管风险方面也起着重要作用。内源性雌激素赋予的心血管保护作用可以通过激素治疗来延长，特别是使用生物等效激素并在绝经后早期开始治疗。
