Prostacyclin from the uterus and woman's cardiovascular advantage

Prostacyclin emanating from the uterus is proposed as a major contributor to the reduced risk of coronary disease among women. The hypothesis is supported by (1) epidemiologic evidence that the risk of myocardial infarction increases markedly following hysterectomy whether or not the ovaries are removed, (2) evidence that premenopausal women may have higher circulating levels of prostacyclin than men of comparable ages, (3) production of prostacyclin by uterine tissue homogenates, (4) preliminary data showing high levels of prostacyclin's stable end-product metabolite in the venous drainage of the uterus, and (5) plausible mechanisms through which prostacyclin could produce a salutary effect on coronary disease. If an appreciable portion of woman's coronary advantage over man relates to differences in uterine production and circulating levels of this natural hormone or similar hormones such as 6-keto-PGE1, then the implications for therapy, prevention, and understanding of the underlying disease processes are considerable. In any case, physicians in practice should recognize the potential of the uterus as a systemically active organ whose removal significantly increases subsequent risk of myocardial infarction.