title: Sex-specific risk of cardiovascular disease and cognitive decline: pregnancy and menopause.
abstract: Understanding the biology of sex differences is integral to personalized medicine. Cardiovascular disease and cognitive decline are two related conditions, with distinct sex differences in morbidity and clinical manifestations, response to treatments, and mortality. Although mortality from all-cause cardiovascular diseases has declined in women over the past five years, due in part to increased educational campaigns regarding the recognition of symptoms and application of treatment guidelines, the mortality in women still exceeds that of men. The physiological basis for these differences requires further research, with particular attention to two physiological conditions which are unique to women and associated with hormonal changes: pregnancy and menopause. Both conditions have the potential to impact life-long cardiovascular risk, including cerebrovascular function and cognition in women. This review draws on epidemiological, translational, clinical, and basic science studies to assess the impact of hypertensive pregnancy disorders on cardiovascular disease and cognitive function later in life, and examines the effects of post-menopausal hormone treatments on cardiovascular risk and cognition in midlife women. We suggest that hypertensive pregnancy disorders and menopause activate vascular components, i.e., vascular endothelium and blood elements, including platelets and leukocytes, to release cell-membrane derived microvesicles that are potential mediators of changes in cerebral blood flow, and may ultimately affect cognition in women as they age. Research into specific sex differences for these disease processes with attention to an individual's sex chromosomal complement and hormonal status is important and timely.
authors.affiliation: Departments of Surgery and Physiology and Biomedical Engineering, 200 1st St SW, Rochester, MN 55905, USA. miller.virginia@mayo.edu.
authors.forename: Virginia M
authors.initials: VM
authors.lastname: Miller
authors.forename: Vesna D
authors.initials: VD
authors.lastname: Garovic
authors.forename: Kejal
authors.initials: K
authors.lastname: Kantarci
authors.forename: Jill N
authors.initials: JN
authors.lastname: Barnes
authors.forename: Muthuvel
authors.initials: M
authors.lastname: Jayachandran
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Mielke
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Joyner
authors.forename: Lynne T
authors.initials: LT
authors.lastname: Shuster
authors.forename: Walter A
authors.initials: WA
authors.lastname: Rocca
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