Severity Of Coronary Artery Disease In Women Research Articles

Estrogen Receptor Beta Gene Variants may be Associated with more Favorable Metabolic Profile in Postmenopausal Women Undergoing Coronary Angiography

Estrogen action is exerted on the vasculature through estrogen receptors ER alpha and ER beta. We have previously reported significant association of ER alpha gene (ESR1) variants with more severe coronary artery disease (CAD) in postmenopausal women. The influence of ER beta gene (ESR2) variants on the cardiovascular system is not well established. We investigated the association of common ESR2 variants with risk factors for cardiovascular disease and with the severity of CAD in postmenopausal women. ESR2 polymorphisms Alu I (1730 G > A) and Rsa I (1082 G > A) were studied in 174 postmenopausal women undergoing coronary angiography (age 45 - 88 yrs). The severity of CAD (0 - 3 vessels with > 50 % stenosis), indices of obesity and other predisposing risk factors for cardiovascular disease, biochemical and hormonal parameters were recorded. 75 women had 0, 39 had one, 37 had two and 23 had three vessels with severe stenosis in the coronary angiography. There was no association between Alu I (allele frequency = 40.2 %) and Rsa I (allele frequency = 2.6 %) variants and CAD severity. Carriers of Alu I had lower BMI (p = 0.044), lower waist perimeter (p = 0.029) and lower total cholesterol (p = 0.033) and LDL levels (p = 0.029). There was no association between Rsa I polymorphism and any metabolic risk factors. ESR2 Alu I polymorphism may have a favorable influence on risk factors for cardiovascular disease such as obesity indices and cholesterol levels. It does not appear to be associated with the severity of CAD in women.

Severity of cardiovascular disease in postmenopausal women: associations with common estrogen receptor α polymorphic variants

Impaired estrogen action is a risk factor for coronary artery disease (CAD). Associations of CAD with estrogen receptor alpha (ER alpha) polymorphisms, which may influence sensitivity to estrogen, have been reported for men; the data concerning women are not conclusive. We investigated the association of common ER alpha polymorphisms with the severity of CAD and with metabolic and reproductive factors in postmenopausal women undergoing coronary angiography. ER alpha polymorphisms at positions c.454-397 T>C (PvuII) and c.454-351 A>G (XbaI) were studied in 157 women (age 45-88 years). The severity of CAD was assessed by the number of arteries with >50% stenosis in the angiography. There was a significant association between the TT, TC, and CC genotypes (PvuII) and the severity of CAD (P=0.008); similar results were obtained for the XbaI polymorphism (P=0.021). These associations were independent of other risk factors for CAD. Women homozygous for the C allele had significantly higher triglyceride and insulin levels; they belonged more frequently to the group with a low number of births (n</=1; P=0.014, Fisher's exact). Common ER alpha polymorphisms may influence the severity of CAD in women undergoing coronary angiography, reflecting lifetime exposure to estrogen. Similar associations have been reported for men with CAD. These polymorphisms should probably be taken into account when associations with estrogenic actions are examined.

Severity of cardiovascular disease in women: Relation with exposure to endogenous estrogen

Objectives Coronary artery disease (CAD) is more common in men than in women. Endogenous sex steroids may be the main factor responsible, as long-term estrogen action appears to be protective. The aim of the study was to investigate the predisposing factors responsible for the severity of CAD in women. Methods One hundred and eight women (100 menopausal) undergoing coronary angiography were studied. Reproductive function was recorded. The severity of CAD was assessed by the number of arteries with severe stenosis, the presence of angina and myocardial infarctions (MI). Results The time since menopause (TSM) was significantly longer in women with angina and with MIs compared to those without (20.3 ± 8.7 years versus 15.8 ± 8.7 years and 22.6 ± 8.6 years versus 18.1 ± 8.9 years, p < 0.05), independently of chronological age. The age at menopause was significantly younger in women who had 2 MIs compared to those with 1 or 0 MI (41.5 ± 3.5, 47.5 ± 5.3 and 48.4 ± 5.4 years, respectively; p = 0.04); the total duration of menstrual cyclicity was inversely related to the number of MIs (35.6 ± 5.8, 34.2 ± 5.3 and 28.3 ± 3.3 years, 0, 1 and 2 MIs, respectively; p = 0.03). Conclusions The severity of CAD in women referred for coronary angiography is correlated with measures of exposure to endogenous estrogen. Both the TSM and the age at menopause are aggravating factors for MI, independently of age. There is an independent protective effect of the duration of estrogen exposure on the number of MIs; this has not been reported before and supports the protective role of the length of exposure to endogenous estrogen, especially for the occurrence of MI in this selected group of women.