REPLACEMENT OF STEROIDS: CARDIOVASCULAR EFFECTS AND INFLUENCE ON CARDIOVASCULAR RISK

In the industrialized nations, coronary heart disease (CHD) is the most fre­ quent cause of death in women. Before the age of 55, the incidence of coro­ nary events in women is only about one third of that in men. After that, it rises steeply, in women aged 75 it reaches the same rate as in men and is even higher in older age [1]. The 10 years difference between men and women in the clinical manifestation of arterio­ sclerosis as well as the increasing inci­ dence of cardiovascular events in women after the age of 55 is often ex­ plained by the anti-atherogenic effect of estrogens. However, little is known about the contribution of androgens to the sex-difference in atherosclerosis. Moreover, it is not clear, whether the increase of CHD-incidence in women after the age of 55 is an effect of age or menopause. In disagreement with the role of menopause as an independent cardiovascular risk factor, the inci­ dence of cardiovascular events rises with the same degree after menopause as before menopause. In contrast, the rate of breast cancer disproportionately increases in postmenopausal women. From this observation, some authors concluded, that menopause is an age­ independent risk factor for breast can­ cer, but not for CHD [2]. Nevertheless, multiple potentially anti-atherogenic properties of estrogens (see below), which are lost upon menopause, result in a more disadvantageous cardiovas­ cular risk factor profile with a higher body mass index, hypertension, total­ and LDL-cholesterol, triglycerides, glu­ cose and fibrinogen (table 1). Also the increased incidence of coronary events after surgical bilateral ovariectomy, if not substituted with estrogens, argues for the causal rel­ evance of menopause as a cardiovas­ cular risk factor.