Liječnički vjesnik (Dec 2022)
Cardiovascular health in menopause
Abstract
Cardiovascular diseases are the most common cause of death in Europe. They are the cause of 40% of deaths in the male population and 49% of deaths in women, which means that 300,000 more women than men die of cardiovascular causes in Europe each year. Most studies have identified menopause as the major contributor to increased cardiovascular risk in women, although it has been methodologically difficult to separate chronological aging from menopause. Pratherogenic changes in lipidogram during transition to menopause may be considered the strongest link between the onset of menopause and the increase in cardiovascular risk. As with blood pressure changes, cohort studies have not found a causal relationship between the onset of menopause and glucose and insulin homeostasis or the risk of developing diabetes. The role of estrogen in maintaining cardiovascular health includes, in addition to all direct cardiovascular effects described above, estrogenic mechanisms that regulate lipid profile, insulin sensitivity, and monocyte-macrophage system, the bursts of which contribute to the multifactorial process of atherosclerosis which considerably modulates cardiovascular risk. Synthesis of numerous studies on molecular mechanisms leads to the conclusion that estrogenic protection of blood vessels and the heart is due to the direct action of estrogen on vasodilation, angiogenesis, improvement of mitochondrial function and reduction of oxidative stress, and suppression of fibrosis. It is important to note that the development of hormone replacement therapy (HRT) has greatly increased the ability to optimize and individualize therapy, further reducing potential risks. With the transdermal route of administration, low- and ultralow-dose therapeutic regimens, and the use of natural micronized progesterone and dydrogesterone, cardiovascular health in menopausal women can be significantly improved.
Keywords
