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How does estrogen protect against heart disease?


Updated June 19, 2014

Question: How does estrogen protect against heart disease?

It is now well-known that estrogen protects women from developing certain types of heart disease. Prior to menopause, women produce sufficient amounts of estrogen to decrease their risk of having a heart attack to much less than that of a man. After menopause, though, estrogen levels fall, and by age 60 to 65, men and women have approximately equal risk. Some recent data suggests that this actually reverses late in life, and that women over the age of 75 might be at higher risk than men of the same age.

How Does Estrogen Protect Against Heart Disease?

While the precise details are unknown, the majority of estrogen’s protective effects probably come from its influence on regulating cholesterol levels. Estrogen acts on the liver to cause an overall reduction in the total amount of cholesterol in the body. Along with this general action, estrogen more specifically increases the amount of good cholesterol (HDL) and decreases the amount of bad cholesterol (LDL).

Over time, bad cholesterol can accumulate into deposits in the blood vessels, leading to blockages that interfere with the delivery of blood to the heart. Decreasing the level of bad cholesterol makes these blockages less likely to form. Good cholesterol, on the other hand, is actually an anti-blockage type of cholesterol. Good cholesterol reduces both the amount of bad cholesterol present in the body and makes bad cholesterol less able to accumulate into the types of deposits that cause blockages.

There is some evidence that estrogen also has an effect on the immune system, which further decreases the danger posed by deposits of bad cholesterol. Once bad cholesterol has deposited in the blood vessels, a complicated immune system reaction causes that area of the vessel to become inflamed. This inflammation leads to further blockage and also increases the risk that a part of the deposit may break off and travel downstream to a narrow area of vessel, where it can lodge and cause a heart attack or stroke.

Despite the protective action of estrogen, women are still at risk of heart disease. Trends over the past several decades show that the number of women suffering from heart disease is on the rise. This is due in part to increased life spans (more women live past the age where the protective effects of estrogen stop), but it is also due to lifestyle choices and habits.

Regardless of age or estrogen level, all women should stop smoking, engage in regular exercise, and work to maintain a healthy diet. These lifestyle adjustments will persist long after the protection offered by estrogen has ceased, and will ultimately lead to a longer, healthier, more enjoyable life.

1. Derry PS. Update on hormones, menopause, and heart disease: evaluating professional responses to the Women's Health Initiative. Health Care Women Int. 29(7):720-37.

2.Sare GM, Gray LJ, Bath PM.Association between hormone replacement therapy and subsequent arterial and venous vascular events: a meta-analysis.Eur Heart J. 2008 Jul.

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