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An In Vivo Estrogen Deficiency Mouse Model for Screening Exogenous Estrogen Treatments of Cardiovascular Dysfunction After Menopause
Published on: August 13, 2019
Menopause and cardiovascular disease: the evidence
G M C Rosano1, C Vitale, G Marazzi
1Department of Medical Sciences, Center for Clinical and Basic Research, Cardiovascular Research Unit, IRCCS San Raffaele, Rome, Italy.
Insights
Menopause increases cardiovascular disease (CVD) risk. Hormone replacement therapy (HRT) with drospirenone/17beta-estradiol may improve CVD risk profiles by reducing blood pressure in postmenopausal women.
Area of Science:
- Endocrinology
- Cardiology
- Women's Health
Background:
- Menopause is a significant risk factor for cardiovascular disease (CVD) due to estrogen withdrawal.
- Estrogen deficiency exacerbates traditional CVD risk factors like altered body fat distribution, impaired glucose tolerance, dyslipidemia, hypertension, and endothelial dysfunction.
- Prioritizing hypertension and glucose intolerance management is crucial for postmenopausal women's cardiovascular health.
Purpose of the Study:
- To evaluate the cardiovascular benefits of hormone replacement therapy (HRT) in postmenopausal women.
- To assess the specific role of drospirenone, a progestogen with antialdosterone properties, in continuous combined HRT.
- To determine if drospirenone/17beta-estradiol can mitigate cardiovascular risks associated with menopause.
Main Methods:
- Review of observational studies and randomized clinical trials on HRT in postmenopausal women.
- Analysis of drospirenone's unique antialdosterone properties and its interaction with the renin-angiotensin-aldosterone system.
- Evaluation of clinical trial data on drospirenone/17beta-estradiol's effect on blood pressure in postmenopausal women.
Main Results:
- Hormone replacement therapy (HRT) initiated early post-menopause may offer cardiovascular benefits.
- Drospirenone counteracts estrogen-induced sodium and water retention, preventing weight gain and hypertension.
- Continuous combined HRT with drospirenone/17beta-estradiol significantly reduced blood pressure in hypertensive postmenopausal women.
Conclusions:
- Drospirenone/17beta-estradiol, as a continuous combined HRT, offers potential cardiovascular benefits beyond symptom relief.
- This HRT formulation may improve the cardiovascular risk profile in postmenopausal women, particularly those with hypertension.
- Management of menopause-related cardiovascular risks can be enhanced with specific HRT formulations like drospirenone/17beta-estradiol.
Abstract:
Menopause is a risk factor for cardiovascular disease (CVD) because estrogen withdrawal has a detrimental effect on cardiovascular function and metabolism. The menopause compounds many traditional CVD risk factors, including changes in body fat distribution from a gynoid to an android pattern, reduced glucose tolerance, abnormal plasma lipids, increased blood pressure, increased sympathetic tone, endothelial dysfunction and vascular inflammation. Many CVD risk factors have different impacts in men and women. In postmenopausal women, treatment of arterial hypertension and glucose intolerance should be priorities. Observational studies and randomized clinical trials suggest that hormone replacement therapy (HRT) started soon after the menopause may confer cardiovascular benefit. In contrast to other synthetic progestogens used in continuous combined HRTs, the unique progestogen drospirenone has antialdosterone properties. Drospirenone can therefore counteract the water- and sodium-retaining effects of the estrogen component of HRT via the renin-angiotensin-aldosterone system, which may otherwise result in weight gain and raised blood pressure. As a continuous combined HRT with 17beta-estradiol, drospirenone has been shown to significantly reduce blood pressure in postmenopausal women with elevated blood pressure, but not in normotensive women. Therefore, in addition to relieving climacteric symptoms, drospirenone/17beta-estradiol may offer further benefits in postmenopausal women, such as improved CVD risk profile.
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