Estrogen's role in cardiovascular health

The place of estrogen in women's health remains controversial. Premenopausal women have a lower prevalence of cardiovascular disease (CVD) than menand hormone replacement therapy (HRT) decreases CVD in postmenopausal women. However clinical trialsfailed to substantiate a protective effect of HRTand even showed some harm. Estrogen rapidly mediatesthe activation of endothelial nitric oxide synthase(eNOS) and increases production of nitric oxide(NO) an important factor for endothelial health.Distinctive results for eNOS NO and superoxidelevels are highlighted by studies on acute and longterm effects of estrogen. In human endothelialcells apoptosis induced by oxidized low-densitylipoprotein and the cytokine TNF? associated withatherosclerosis is reduced by estrogen. Estrogen's angiogenic properties help healthy endotheliumrespond to injury but they also potentiate TNF?-induced angiogenesis which revascularizes plaquesof women with advanced atherosclerosis andexacerbates cardiovascular events. Researchers and clinicians could appreciate this contribution to the undestanding of the paradoxical effects of estrogen on the vascular wall.