The roles of gender, the menopause and hormone replacement on cardiovascular function

Time for primary review 22 days. While it is recognised that gender differences exist in cardiovascular disease, it has only recently been appreciated that significant gender differences also exist in cardiovascular function. Ageing is associated with a different spectrum of cardiac and vascular maladaptations in women compared to men. These differences may contribute to poorer outcome in women affected by ischaemic disease compared to men as well as the higher prevalence of symptomatic cardiac failure seen in women. The most obvious gender-related difference in physiological ageing is the menopause in women. The relation of this ‘event’ to cardiovascular disease has generated much controversy, especially with respect to hormone replacement therapy in the management of cardiac patients. Controversy also exists in the role of declining androgen levels in men with age and the advisability of testosterone supplementation in men. This review will examine gender differences which become apparent due to ageing, as well as the specific effect of the menopause and hormone replacement on cardiac and vascular structure and function. It will also summarise the impact of these physiological and epidemiological differences on the expression of cardiovascular disease in men and women. Studies examining the role of gender and hormone withdrawal and administration in animal studies will also be summarised. Limitations in current research and recommendations for future areas of research are put forward. Because of the higher cardiac mortality in men compared to women until late in life 1, most early studies focused exclusively on that gender. Women have been excluded from research protocols during childbearing years and in old age because of co-morbidities 2. Recently research emphasis has shifted in line with the recognition that cardiovascular disease remains the most prevalent illness affecting women and remains the most frequent cause of female death in most Western nations … * Corresponding author. Tel.: +44-171-351-8112; fax: +44-171-823-3392 peter. collinsatic. ac. uk