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[Menopause and cardiovascular risk factors. Influence of treatments]
1Centre Hospitalier Chirurgical Foch, Suresnes.
Insights
Menopause increases cardiovascular disease risk due to cholesterol changes. Hormone replacement therapy
Area of Science:
- Endocrinology and Cardiovascular Health
- Menopause-related cardiovascular risk factors
Context:
- Menopause is associated with increased cardiovascular disease (CVD) risk, marked by altered lipid profiles, particularly increased LDL cholesterol.
- The impact of hormone replacement therapy (HRT) on CVD risk remains unclear due to a lack of randomized studies, leading to potential selection bias in existing data.
- Understanding the specific mechanisms of HRT is crucial for extrapolating its effects on risk factors.
Purpose:
- To analyze changes in cardiovascular risk factors associated with menopause.
- To evaluate the influence of different hormone replacement therapy (HRT) administration routes on cardiovascular risk factors.
- To investigate the impact of oral versus non-oral estradiol on lipid profiles and other risk factors.
Summary:
- Non-oral estradiol administration appears to restore lipid balance to premenopausal levels without significantly affecting other risk factors, suggesting a favorable influence.
- Oral estradiol administration can lead to favorable lipid changes but also induces potentially unfavorable variations, including increased coagulation factors, angiotensinogen, and triglyceride levels.
- The long-term consequences of oral estradiol-induced changes in coagulation factors and triglycerides on HDL cholesterol remain unknown and require further investigation, especially in predisposed individuals.
Impact:
- Highlights the importance of administration route in HRT for cardiovascular health outcomes.
- Identifies specific hormonal changes associated with oral HRT that warrant further investigation regarding their cardiovascular implications.
- Provides a basis for future research to clarify the safety and efficacy of different HRT regimens in managing menopausal cardiovascular risk.
Abstract:
Along with menopause goes an increase of cardiovascular heart disease risk, and at the same time a change in certain risk factors. Those risk factor changes are analysed. The most obvious change is cholesterol increase, mostly on its LDL fraction linked to a decrease of its regular epuration. Today, the influence of replacement therapy on cardiovascular heart disease risk is not well known, and this is due mostly to the fact that there are no randomized studies. Thus exists a selection of women with low risk levels, either at the beginning or during follow-up. As a consequence results are necessarily optimized. It is possible to extrapolate the risk factor evolution under treatment only if its mechanism is known. Thus, when estradiol is given not the oral route, lipidic balance is brought back to its premenopausal state, without any noticeable influence on other known risk factors. It is thus reasonable to see there a favorable influence. When estradiol or any other similar molecule is given the oral route, one can notice, depending on the dose and the molecule, similar changes, along however with other variations which actual consequences remain unknown, like the increase of certain coagulation factors, of angiotensinogen, of triglycerides on HDL cholesterol. In particular, one does not know if those last pharmacological changes do not have a negative effect on predisposed patients.