ABSTRACT
In most Western societies, the incidence of coronary heart disease and coronary artery atherosclerosis (McGill and Stern, 1979) are much lower in premenopausal women than in men of similar age. The widespread belief that ovarian estrogen is responsible for this relative sparing of the coronary arteries is supported by compelling evidence that estrogen replacement therapy is associated with a marked reduction in angiographically-defined extent of coronary artery atherosclerosis (Adams et al., 1987a) and risk of coronary heart disease in postmenopausal women (Bush, 1990). The mechanisms involved in estrogen’s apparent protective effects remain unclear. Among multiple possibilities are inhibitory effects on atherosclerosis progression and coronary thrombosis, and beneficial effects on vasomotor function of coronary arteries. Also unclear are effects of combination hormone treatment, i.e., estrogen plus progestin or androgen, on atherosclerosis and coronary heart disease risk.
