Cardiovascular disease in postmenopausal women

Cardiovascular disease is a major cause of death in both sexes. Women suffer almost as many myocardial infarctions as men, although they tend to occur at a greater age. Prevention programs for heart disease have impacted more positively on men than women and relatively young women aged 35-54 years may have fared worse. Hypertension is more prevalent amongst younger men than women, but above 65 years of age it becomes more common in women. Adequate treatment of hypertension has many rewards, but is only received by a minority of hypertensives. Heart failure, too, is a major burden of cardiovascular disease, particularly in older women. Approximately 30% of all cardiac surgery is performed on women, who have a worse short-term postoperative prognosis than men, although the two sexes fare equally in long-term survival. Hypertension, heart failure and diabetes have been identified as key preoperative factors determining a poorer prognosis for cardiac surgery amongst women. The renin-angiotensin-aldosterone system is thought to be central to the development of cardiovascular disease, with elevated levels of angiotensin II hypothesized as the factor which stimulates the formation of large insulin-resistant adipocytes, en route to diabetes. At the cellular level, estrogens have many effects on cardiovascular cells capable of being interpreted as beneficial in terms of cardiovascular disease. New studies demonstrate that approximately 5% of proteins produced by human myocardial cells are modulated by estrogens, estrogens receptors are modulated by age and disease, and estrogens modulate expression of receptors for endothelin-1, a neurohormone implicated in cardiovascular disease.