Abstract-Although recent clinical trials have found an increased incidence of cardiovascular disease in women on estrogen replacement therapy, the underlying mechanism remains unclear. We have recently characterized DahlS.Z-Lepr fa /Lepr fa (DS/obese) rats, derived from a cross between Dahl salt-sensitive and Zucker rats, as a new animal model of metabolic syndrome. We have now examined the effects of estrogen replacement on cardiac pathophysiology in ovariectomized female DS/obese (Ovx-DS/obese) rats. Animals subjected to ovariectomy at 7 weeks of age were implanted subcutaneously with a 60-day release pellet containing 0.5 mg of 17-estradiol (E 2 ) or placebo at 8 weeks. Age-matched female homozygous lean littermates (DahlS.Z-Lepr ϩ /Lepr ϩ or DS/lean rats) of DS/obese rats served as controls. Animals were maintained on a normal diet and were subjected to echocardiography followed by various pathological analyses at 13 weeks of age. Ovx-DS/obese rats manifested hypertension at 7 weeks of age and thereafter and showed left ventricular (LV) fibrosis and diastolic dysfunction at 13 weeks. Treatment with E 2 attenuated hypertension in Ovx-DS/obese rats but had no effect on blood pressure in ovariectomized female DS/lean (Ovx-DS/lean) rats. E 2 treatment exacerbated LV fibrosis and diastolic dysfunction, as well as further increased cardiac oxidative stress and inflammation in Ovx-DS/obese rats, and it elicited similar effects in Ovx-DS/lean rats. E 2 reduced food intake, body weight, and visceral fat content in both Ovx-DS/obese and Ovx-DS/lean rats. E 2 treatment attenuated hypertension and obesity but exacerbated LV fibrosis and diastolic dysfunction in Ovx-DS/obese rats, with these latter effects being associated with increased cardiac oxidative stress and inflammation. (Hypertension. 2012;59:694-704.) • Online Data Supplement Key Words: metabolic syndrome Ⅲ estrogen Ⅲ hypertension Ⅲ myocardial fibrosis Ⅲ diastolic dysfunction Ⅲ oxidative stress Ⅲ inflammation M etabolic syndrome (MetS), a complex of highly debilitating disorders including hypertension, diabetes mellitus, and dyslipidemia, is associated with the development of visceral obesity. 1 MetS afflicts both men and women and increases the risk of heart disease in both sexes, although it appears to inflict a greater burden in women. The incidence of cardiovascular disease among women is low before menopause but steadily increases thereafter. 2 This increase is thought to result in part from the loss of endogenous estrogen and its associated cardioprotective effects. 3 A key issue faced by most postmenopausal women is the potential impact of estrogen replacement therapy on the prevalence of cardiovascular disease. Estrogen replacement in postmenopausal women has been associated with a reduced risk of cardiovascular disease. 4 However, the Heart and Estrogen/Progestin Replacement Study 5 and the Women's Health Initiative Study 6 do not support the notion that hormone replacement therapy protects the cardiovascular system but rather suggest the opposite vi...