Sex-Specific Determinants of Coronary Artery Disease and Atherosclerotic Risk Factors: Estrogen and Beyond |
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| Affiliation: | 1. Departments of Medicine, of Physiology & Pathophysiology, of Pharmacology & Therapeutics, University of Manitoba, Winnipeg, Manitoba, Canada;2. Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada;1. School of Medical Sciences, University of Campinas, Campinas, Brazil;2. Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands;3. Cardiology Division. Department of Internal Medicine, University of Campinas, Campinas, Brazil;4. Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand;5. Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands;6. First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland;7. Cardialysis Clinical Trials Management and Core Laboratories, Rotterdam, The Netherlands;8. Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal;9. Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil;10. Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil;11. East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom;12. Kerckhoff Heart Center, Campus University of Giessen, Bad Nauheim, Germany;13. Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, Canada;14. Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium;15. Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Switzerland;p. Galway University Hospital, National University of Ireland, Galway, Ireland;q. French Alliance for Cardiovascular Trials, Hopital Bichat, Assistance Publique-Hopitaux de Paris, Universite Paris-Diderot, and Institut National de la Sante et de la Recherche Medicale U-1148, Paris, France;r. Royal Brompton Hospital, Imperial College, London, United Kingdom;1. Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria;2. Division of Endocrinology and Metabolism, Mayo Clinic College of Medicine, Rochester, MN, USA;3. Department of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria;4. Complexity-Research, Research Institute for Complex Systems, Vienna, Austria;5. 4th Medical Department, Hietzing Hospital, Vienna, Austria;1. Laboratory of Central Neuropeptides in the Regulation of Body Fluid Homeostasis and Cardiovascular Functions, Collège de France, Center for Interdisciplinary Research in Biology, Centre National de la Recherche Scientifique UMR 7241, Institut National de la Santé et de la Recherche Médicale U1050, Paris, France;2. Quantum Genomics, Paris, France;3. Centres d’Investigation Clinique 1418, Institut National de la Santé et de la Recherche Médicale, Paris, France;4. Hypertension Unit and Départements Médico-Universitaires Cardiovasculaire, Rénal, transplantation et neurovasculaire (DMU CARTE), l’Assistance Publique–Hôpitaux de Paris, Hôpital European Georges-Pompidou, Paris, France |
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| Abstract: | The way we view coronary artery disease in women has changed dramatically over the past decades. From an initial perspective that coronary artery disease was a male disorder and that women were protected by estrogens, there has been the gradual appreciation that this is an equal opportunity disease. Postmenopausal women are more likely than men to be hypertensive, dyslipidemic, and have multiple risk factors. Beyond the appreciation of estrogen’s global effects on cardiovascular and metabolic function, our further advances in the understanding of sex-specific risks and management will be based on a greater understanding of the diversity of estrogen-mediated receptor pathways, including appreciation of the sometimes divergent effects of estrogen when acting either via the classic estrogen receptor or the more recently appreciated G protein–coupled estrogen receptor. In addition, the importance of sex-specific regulation of cardiometabolic processes beyond the sex hormones, specifically via SRY regulation, is only beginning to be understood. Finally, the author summarizes his recent studies demonstrating sex-specific G protein–coupled estrogen receptor regulation of blood pressure and cholesterol metabolism that may serve as a paradigm for the elucidation of sex-specific determinants of cardiovascular risk and the basis for sex-specific management of those risks. |
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