Progestogen effects at vascular level: the endothelial cells

Progesterone and progestogens are active molecules on the cardiovascular system. However, their action is not as well-characterized as the effects of estrogens. Data of the last clinical trials suggest the possibility of harmful cardiovascular effects of progestogens, and the debate on the role of progesterone and progestins on the vascular wall is open. From an experimental point of view, each progestogen presents typical effects on the cardiovascular system and their administration results in diverse modifications of the effects of estrogens, sometimes acting synergically, others being neutral or antagonizing effects of estrogens. In this paper, we review the most important data from in vivo and in vitro studies which have been published on the effects of progesterone and progestogens on vascular cells. Endothelium is a target tissue for sex steroids and progesterone is able to regulate endothelial cell function and morphology. Even if the perfect molecule does not exist, the understanding of the molecular basis of each progestogen in vascular tissue is therefore of paramount importance for the most appropriate use with an optimal cardiovascular profile.