Estrogens, progestins, selective estrogen receptor modulators, and the arterial tree.
We reviewed studies of the effects of different estrogens, progestins, and selective estrogen receptor modulators at the coronary and carotid arterial sites to help determine their likely effects on cardiovascular morbidity and mortality. All English-language studies published between 1997 and 2000 on MEDLINE, Current Contents, and Best Evidence were reviewed, including in vitro, other animal, human physiologic, and clinical trial studies. We synthesize, assess limitations, and integrate across systems with the in vivo experience in humans to evaluate the clinical context. Estrogens have favorable direct effects in most circumstances, progestins oppose these effects, and early studies suggest that selective estrogen receptor modulators are protective. In some systems the dosage, route of delivery, and type of progestin may be important and risk factors may modulate hormone effects. The evaluation of endothelial dysfunction gives a unique in vivo opportunity to assess the vascular properties of hormones, although the relationship between the in vivo physiologic effects of hormones and clinical outcomes remains to be determined.
Wild
R A
RA
Reproductive Endocrinology Section, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
Reis
S E
SE
D000818:Animals; D002339:Carotid Arteries / Q000187:drug effects*; D002340:Carotid Artery Diseases / Q000517:prevention & control; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000517:prevention & control; D003331:Coronary Vessels / Q000187:drug effects*; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000494:pharmacology*; D005260:Female; D006801:Humans; D011372:Progestins / Q000494:pharmacology*; D020845:Selective Estrogen Receptor Modulators / Q000494:pharmacology*
D004967:Estrogens; D011372:Progestins; D020845:Selective Estrogen Receptor Modulators