Detrimental effects of endogenous oestrogens on primary acute myocardial infarction among postmenopausal women

Dong, Maolong; Guo, Feifei; Yang, Jun; Liu, S.; Tao, Z.; Fang, Yajing; Zhang, C.; Li, J.; Li, G.

doi:10.1007/s12471-012-0323-5

Cited by 6 publications

(16 citation statements)

References 32 publications

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“…However, several studies have found no association between sex hormone levels and risk of death from CVD . We found a positive relationship between higher estradiol levels and risk of AMI in postmenopausal women . Exogenous hormones have been documented to increase risk of CVD in women and were not able to prevent recurrent myocardial infarction in postmenopausal women .…”

Section: Discussioncontrasting

confidence: 68%

“…Myocardial no‐reflow is defined as inadequate myocardial perfusion of a given coronary segment without angiographic evidence of mechanical vessel obstruction . We proved that endogenous estrogen was an independent risk factor of ST‐elevation myocardial infarction (STEMI) in postmenopausal women . We now examine the effects of endogenous estrogen on no‐reflow in postmenopausal women with STEMI.…”

Section: Introductionmentioning

confidence: 99%

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Prospective Study of Effects of Endogenous Estrogens on Myocardial No‐Reflow Risk in Postmenopausal Women with Acute Myocardial Infarction

Dong

Ren

et al. 2014

J Interven Cardiology

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The relationship between endogenous estrogens and cardiovascular disease in menopausal women remains poorly understood. Studies examining the relationship have yielded conflicting results. Therefore, we performed this study to prospectively assess the effects of endogenous estrogen on the risk of myocardial no-reflow in postmenopausal women with ST-elevation myocardial infarction (STEMI). Consecutive 100 postmenopausal women diagnosed with STEMI and who had undergone emergence percutaneous coronary intervention (PCI) were included in this study. Blood samples were obtained before PCI and assayed for endogenous sex hormones. Logistic regression models were developed with adjustment for confounders. Compared with normal-reflow group, the circulating levels of estrone, estradiol, sex hormone binding globulin (SHBG), and hypersensitive C-reaction protein (Hs-CRP) were significantly higher in the no-reflow group (P < 0.05). In univariable logistic regression models, lesion length, reference luminal diameter, thrombus score ≥ 4, and the levels of estrone, estradiol, and SHBG were all found to be positively associated with the risk of no-reflow (P < 0.05). After adjusting for these factors, thrombus score ≥ 4 (OR = 4.994, CI 1.987-10.518; P = 0.035), SHBG (OR = 0.800, CI 0.341-0.983; P = 0.047), and estradiol levels (OR 4.091, CI 1.105-8.582; P = 0.046) continued to demonstrate strong positive associations with the risk of no-reflow. Our data showed that high circulating levels of endogenous estrogens have a positive and statistically significant relationship with no-reflow in postmenopausal women with STEMI. It has been suggested that estrogens may have a potential detrimental effect on myocardial no-reflow. However, our results need to be confirmed in a larger population.

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Section: Discussioncontrasting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Prospective Study of Effects of Endogenous Estrogens on Myocardial No‐Reflow Risk in Postmenopausal Women with Acute Myocardial Infarction

Dong

Ren

et al. 2014

J Interven Cardiology

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“…Where we assumed that increased levels of female sex hormones were protective against the development of cardiovascular disease, our colleagues Mei Dong et al from Yantai, China suggest quite the opposite. In their paper published in this edition of the Netherlands Heart Journal the authors describe a relation between the occurrence of a myocardial infarction (MI) in post-menopausal women and levels of sex hormones [1]. They report that high levels of oestradiol and increased waist-to-hip ratio (WHR) are related to the occurrence of acute MI.…”

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confidence: 99%

Postmenopausal sex hormones: comparing apples and pears

Appelman

Lambalk

2013

Neth Heart J

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The sex hormone story in relation to cardiovascular disease is always good for a surprise. Where we assumed that increased levels of female sex hormones were protective against the development of cardiovascular disease, our colleagues Mei Dong et al. from Yantai, China suggest quite the opposite. In their paper published in this edition of the Netherlands Heart Journal the authors describe a relation between the occurrence of a myocardial infarction (MI) in post-menopausal women and levels of sex hormones [1]. They report that high levels of oestradiol and increased waist-to-hip ratio (WHR) are related to the occurrence of acute MI.This story is confusing. From an epidemiological perspective it was shown that in women there is a relation between the onset of the menopause and the risk of MI. Based on these observations studies were initiated to supply sex hormones in order to postpone the onset of atherosclerosis. Yet the beneficial effects of hormone replacement therapy were off set by the induction of thrombosis, likely in subjects who already had coronary artery disease [2]. However, recent publications might change this view, as a recent paper by Schierbeck from Denmark demonstrated that an early start of hormone replacement therapy seems to benefit and decreases future atherosclerotic events [3]. Moreover, it is well known that women with premature menopause have an earlier onset of atherosclerosis.An important restriction of the paper by Dong et al. is the patient selection and moreover the control population. It is obvious they selected pears and apples. The control group had lower WHR and lower levels of sex hormones. They also had a lower body mass index (BMI). These are clearly the pears with a preserved waist size, and they were recruited at random with two controls matched for age only. The infarct patients had higher BMI and higher WHR describing the apple shape. The value of the waist-to-hip ratio with increase in BMI is relative and some studies suggest that with a BMI above 30 the relevance of the WHR is lost. In addition the cases more often had hypertension and diabetes. These are all changes related to the postmenopausal status and it is well known that all these factors contribute to an increased risk for MI. So clearly the groups are very different. The question is to what extent do the sex hormone levels contribute independently? It has been reported that sex hormone levels are positively related to the total amount of fat tissue, with an inverse relation to sex hormone binding globulin [4]. So it is not unlikely that in the current study the observed higher oestrogen levels are an association with known risk factors that lead to MI rather than being causative. In fact, in postmenopausal women androgen secretion originates from the ovarian hilus driven by high gonadotropins and the adrenal gland driven by adrenocorticotrophic hormone and the oestrogens come from peripheral conversion of these androgens. Their fat tissue is the predominant source of oestrogens via its high aromatase potentia...

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“…In recent years many clinical trials have provided evidence that there are substantial gender differences in the pathophysiology, clinical presentation, diagnosis, and treatment of CAD [1][2][3][4][5]. Although women have a higher atherosclerotic burden, they are more symptomatic and have a lower prevalence of obstructive CAD than men [6][7][8][9][10].Whether these gender differences translate into different clinical outcomes in stable CAD has been unclear. While some reports found gender differences in outcomes for stable angina or acute coronary syndromes, others did not [11][12][13][14][15].…”

mentioning

confidence: 99%

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confidence: 99%

Women and men with stable coronary artery disease: different risk factors but similar outcomes!

Wall

2013

Neth Heart J

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Men and women differ in terms of presentation and management in coronary artery disease (CAD). In recent years many clinical trials have provided evidence that there are substantial gender differences in the pathophysiology, clinical presentation, diagnosis, and treatment of CAD [1][2][3][4][5]. Although women have a higher atherosclerotic burden, they are more symptomatic and have a lower prevalence of obstructive CAD than men [6][7][8][9][10].Whether these gender differences translate into different clinical outcomes in stable CAD has been unclear. While some reports found gender differences in outcomes for stable angina or acute coronary syndromes, others did not [11][12][13][14][15]. Furthermore, most contemporary studies of CAD patients are limited to a single country or specific geographical region, or a particular manifestation of disease such as angina symptoms or acute myocardial infarction [16][17][18]. Recently, dr. Gabriel Steg et al. (Paris, France) analysed data from the international prospective CLARIFY registry to compare cardiovascular clinical outcomes in men and women with stable CAD [19]. CLARIFY (ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) is an ongoing international prospective observational longitudinal registry in 33,000 patients with stable CAD in 45 countries. One-year outcomes were analysed in 30,977 outpatients with stable CAD of whom 23,975 (77.4 %) were men and 7002 (22.6 %) were women. Based on risk profiles, women were older than men, were more likely to have hypertension and diabetes, did less exercise and smoked less. Women had more frequent angina, but were less likely to have undergone diagnostic non-invasive testing or coronary angiography. Women received less optimised treatment for stable CAD. However, 1-year outcomes were similar for men and women: 1) for the composite of cardiovascular death, non-fatal myocardial infarction, or stroke (1.7 vs. 1.8 %, respectively), 2) all-cause death (1.5 vs. 1.6 %), 3) fatal or non-fatal myocardial infarction (1.0 vs. 0.9 %,), and 4) cardiovascular death or non-fatal myocardial infarction (1.4 vs. 1.4 %,). Fewer women underwent revascularisation (2.6 vs. 2.2 %).It was concluded by the authors that, although the risk profiles of women and men with stable CAD differed substantially, the 1-year outcomes were similar in terms of mortality and cardiovascular events. These results suggest that there is no discernible excess of cardiovascular events in women with stable CAD compared with men and that, if anything, among younger patients or lower risk patient groups, women actually fare better than men.The study has been criticised by dr. Eva Swahn (Stockholm, Sweden) in an accompanying Editorial comment [20]. Her main critical comments were the following. First, the patients seem to be highly selected, as only 22.6 % were women and, according to epidemiological investigations, the prevalence is usually the same and in fact even slightly higher in women with angina. As the physicians involve...

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Detrimental effects of endogenous oestrogens on primary acute myocardial infarction among postmenopausal women

Cited by 6 publications

References 32 publications

Prospective Study of Effects of Endogenous Estrogens on Myocardial No‐Reflow Risk in Postmenopausal Women with Acute Myocardial Infarction

Prospective Study of Effects of Endogenous Estrogens on Myocardial No‐Reflow Risk in Postmenopausal Women with Acute Myocardial Infarction

Postmenopausal sex hormones: comparing apples and pears

Women and men with stable coronary artery disease: different risk factors but similar outcomes!

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