[Coronary disease in women: The role of sexual hormones].
During their lives, women go through three different phases during which sex hormones play a fundamental role in contributing to specific cardiovascular and coronary risks. To evaluate this risk, we must take into account these various phases with their associated cardiovascular risk factors, and this during three key steps: contraception, pregnancy and menopause. Arterial risk linked to estrogen combined with progestin contraception, depends on the dosage of estrogen. The main cardiovascular risk factor responsible for increasing the risk of myocardial infarction is tobacco, especially after 35 years of age, contraindicating estrogen combined with progestin contraception at the benefit of progestin. Spontaneous dissections and coronary emboli are the most common coronary lesions linked with oestroprogestative contraception. Acute myocardial infarction during pregnancy occurs mostly in the peripartum or postpartum period; and is often caused by spontaneous coronary dissection lesions. Fertility treatment is not associated with an increased risk of developing cardiovascular disease later in life. Hormone therapy during menopause does not increase coronary risk in the first 10 years after menopause and may even have a protective effect, by sustaining arterial integrity. The transdermal route is to be preferred for its metabolic effect. Hormonal treatment during menopause is nonetheless contraindicated in the case of proven coronary disease and uncontrolled cardiovascular risk factors.
Clinique de cardiologie, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France. Electronic address: evautrin@chu-grenoble.fr.
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Vautrin
Clinique de cardiologie, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
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Marlière
Clinique de cardiologie, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
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Bouvaist
Clinique de cardiologie, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
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Guerbaai
Clinique de cardiologie, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France; Inserm, U1039, radiopharmaceutiques biocliniques, 38043 Grenoble cedex 09, France.
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Barone-Rochette
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000503:physiopathology; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage / Q000009:adverse effects; D003327:Coronary Disease / Q000503:physiopathology*; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000502:physiology; D005260:Female; D012739:Gonadal Steroid Hormones / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000503:physiopathology; D012306:Risk; D012307:Risk Factors
D003277:Contraceptives, Oral, Combined; D004967:Estrogens; D012739:Gonadal Steroid Hormones
Atherosclerosis; Athérosclérose; Contraception estroprogestative; Coronary risk; Estrogen; Estrogènes; Grossesse; Hormonal contraception; Medically assisted procreation; Menopause; Menopause hormone therapy; Ménopause; Pregnancy; Procréation médicalement assistée; Risque coronarien; Traitement hormonal substitutif