Atherosclerosis and sex hormones: current concepts

Area of Science:

• Cardiovascular Science
• Endocrinology
• Pathobiology

Background:

• Cardiovascular disease (CVD) is the primary cause of mortality in women.
• Advances in understanding menopausal hormone therapy and hormone receptor function are crucial.
• The interaction between atherosclerosis, sex steroid hormones, and their receptors in the vessel wall has significant clinical implications.

Purpose of the Study:

• To review the epidemiology of CVD in both sexes.
• To examine the clinical impact of sex hormones on CVD.
• To summarize the current understanding of atherosclerosis pathogenesis, emphasizing gender differences and pathobiology.

Main Methods:

• Review of epidemiological data on CVD in men and women.
• Analysis of clinical studies on the impact of sex hormones on CVD.
• Examination of animal and human data on oestrogens, androgens, and progestins in atherogenesis.
• Discussion of systemic effects of sex hormones on vascular reactivity, inflammation, and lipoprotein metabolism.

Main Results:

• Atherosclerosis pathogenesis exhibits significant gender differences in clinical presentation and pathobiology.
• Sex hormones differentially affect key vascular cell types: endothelium, smooth muscle cells, and macrophages.
• Systemic effects of sex hormones on inflammation and metabolism influence atherogenesis.

Conclusions:

• Understanding the role of sex hormones in atherosclerosis is critical for developing gender-specific CVD prevention and treatment strategies.
• Key areas for future research include hormone exposure time, tissue specificity, timing of hormone action, biomarkers, and the role of sex steroids in inflammation.
• This knowledge will inform clinical treatment recommendations for women and guide future research priorities.