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originated Sept 2006, updated Dec 2008 A non profit global health initiative
to provide medical perspective about menstrual health
the menopausal transition and post-menopausal health
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global health requires your compassion | | Cholesterol Women and Estrogen 
At age 32 a woman's HDL cholesterol is about 63 mg/dl. Around age 60 a woman's HDL drops to a troublesome 46.72 mg/dl | Lipoproteins transport fats (lipids) and proteins in the blood.
Low density lipoprotein (LDL) transports cholesterol from the liver to arteries... not good. High density lipoprotein (HDL) transports cholesterol away from arteries to the liver to be removed from the body... this is good. HDL concentrations at 40 mg/dl present a high risk of clogged/inflammed arteries An HDL level of 60 mg/dl is protective; more cholesterol is being removed from the arteries. |
 | Hormone Replacement effects Cholesterol As estrogen (estradiol) levels fall due to menopause, lipids; fats and cholesterol in the blood often increase. High density lipoprotein (HDL) concentrations, the good cholesterol tends to decrease on average 11-14%. Post menopausal cholesterol levels gradually change to effect a substantial increase in low density lipoprotein cholesterol (LDL) and apo-lipoprotein B (a type of troublesome cholesterol discussed below) and a 15 percent increase in total cholesterol. | | | These postmenopausal cholesterol changes are significant because every one percent increase in total cholesterol reflects a two percent increased risk of cardiovascular disease. Estrogen replacement therapy in postmenopausal women is associated with a reduction in LDL cholesterol and an increase of HDL cholesterol.
Metabolic studies suggest that the reduction in LDL cholesterol levels with estrogen replacement therapy is a result of enhanced lipoprotein uptake by the liver, accelerated conversion of cholesterol in the liver to bile acids and increased expression of LDL receptors on hepatocytes (liver cells). This results in improved removal of LDL cholesterol particles.
High density lipoproteins (HDL) travel in the blood, target cholesterol deposits in the lining of an artery and carry them back to the liver for disposal. High density lipoproteins also prevent oxidation (decay) of LDL cholesterol and diminish the ability of LDL cholesterol to stick to the endothelial cells lining the arteries. High HDL cholesterol levels are also associated with anti-inflammatory actions.
Low HDL cholesterol levels are a strong predictor of coronary artery disease risk in women. It is estimated that for every 1 mg/dL increase in HDL-C, there is a 3% decrease in risk of coronary artery disease and a 4.7% decrease in the risk of death from cardiovascular disease. For women HDL concentrations close to 60 mg/dL are optimal and significantly protect the integrity of the vascular wall. HDL concentrations of 40 mg/dL are considered unhealthy because not enough cholesterol is being removed from the arteries.
The increase in HDL cholesterol levels in response to estrogen replacement is thought to be generated by increased production of apolipoprotein A1, the major apolipoprotein of HDL, and by decreased hepatic lipase activity that enhances the uptake of HDL-C and the breakdown of HDL-2; the subpartical considered the most active in reverse cholesterol transport.
There are important differences in the effects of various hormone replacement therapies on lipids/lipoprotein metabolism, coagulation (clotting of blood), and fibrinolysis (breakdown of blood clots). When utilizing hormone replacement therapy to preserve bone health or for hot flashes, it is important to find a healthcare professional with formidable knowledge regarding how estrogen replacement (ET) and hormone replacement (estrogen/progestin HRT) their dosages and delivery effects lipoprotein metabolism and other cardiovascular risk factors.
Source:
Raloxifene: A Selective Estrogen Receptor Modulator
Janine A. Scott MD
American Family Physician: Clinical Pharmacology C-Reactive Protein and Hormone Replacement 1999 | | | | |
An Important Point About Cholesterol: HDL cholesterol concentrations at 60 mg/dl are cardio-protective. Oat bran, prunes, red wine, dark chocolate contribute to positive HDL concentrations. In general, the higher your HDL-C, the greater your capacity to remove cholesterol and prevent dangerous blockages from developing in blood vessels. HDL-C helps keep blood vessels widened (dilated), thereby promoting better blood flow. HDL-C also reduces blood vessel injury through its antioxidant and anti-inflammatory functions. Source: The "Good Cholesterol" High-Density Lipoprotein Peter P. Toth, MD, PhD University of Illinois School of Medicine, Peoria. Circulation. 2005;111:e89-e91. | |  Low HDL cholesterol is the most common abnormality in individuals with coronary heart disease and is predictive of subsequent coronary heart disease events, even when total cholesterol is within the desirable range. Source: Michael Miller MD Director, Center for Preventive Cardiology Dept of Medicine and Epidemiology University of Maryland Medical Center, Baltimore. | |
Different Types of Hormone Replacement effect C-Reactive Protein and Cardiovascular Risk
C-reactive protein (CRP) is an acute phase protein produced by the liver in response to tissue injury, inflammation, or infection. The physiological role of
C-reactive protein is to direct inflammatory remnants to phagocytic cells of the lymphatic system for elimination.
Studies have shown that plasma levels of CRP are a strong independent predictor of endothelial dysfunction, future heart muscle (myocardial) dysfunction, stroke, and peripheral artery disease among individuals without known cardiovascular disease.
Hormone replacement therapy for menopausal and postmenopausal women effects CRP levels. The effect of estrogen replacement on CRP is dependent on the route of administration. Studies show that transdermal estrogen replacement does not effect CRP levels where oral estrogen replacement therapy increases CRP levels in many women. If you are using oral estrogen replacement it is a good idea to have your CRP levels monitored.
Transdermal estrogen replacement is not subject to first pass metabolism by the liver, this allows for lower doses and exposes tissues to lower drug levels. Lower exposure in the liver impacts protein and lipid synthesis. As such, in postmenopausal women, oral but not transdermal ET increased CRP by a first-pass hepatic effect. An increase in CRP levels is accompanied by a reduction in IGF-1, an anti-inflammatory growth factor.
Source:
Differential effects of oral versus transdermal estrogen replacement therapy on C-reactive protein in postmenopausal women
Wanpen Vongpatanasin, MD, FACC Meryem Tuncel, MD, Zhongyun Wang, MD. J Am Coll Cardiol, 2003; 41:1358-1363 1999 |
 | Apo-lipoprotein B more accurately identifies coronary artery disease risk than LDL cholesterol levels
The incidence of cardiovascular disease in women increases after menopause in part due to an increase of low density lipoprotein (LDL) cholesterol and apolipoprotein B.
| | | | Apolipoprotein B are small, low density lipoprotein particles. Small, low density lipoprotein particles are more likely to generate fatty deposits in the lining of the artery (atheromas) than normal LDL particles. Fatty deposits nest in the artery lining. They become decayed and swollen/inflamed and begin to narrow the coronary arteries. This reduces blood flow to the heart.
Apolipoprotein B particles, are more common in people with coronary artery disease than an increased LDL cholesterol level.
The level of apolipoprotein B continues to predict coronary artery disease risk during statin treatment. As such, apolipoprotein B levels should continued to be monitored while using statin medication. Apolipoprotein B testing does not require fasting and is standardized in most laboratories.
| | | Statins | | | | | Statins are prescription medications that inhibit the liver enzyme that creates cholesterol. Statins cause a decrease in production and an increase in the breakdown of cholesterol. As a result less low density lipoprotein cholesterol (LDL-C) is transported to the arteries. Note: in general it is beneficial for men and women to take a daily Co-enzyme Q10 supplement (75-100 mg) if you are taking a statin. Co-enzyme Q10 levels are reduced by statin therapy because it shares the hepatic mevalonate synthetic pathway with cholesterol. | | | | In addition to lowering cholesterol statin medications:
1) improve the protective function of endothelial cells that line the arteries.
2) have an anti-oxidant effects, they help prevent low density lipoprotein from decaying (oxidizing) in the arteries.
3) have anti-inflammatory effects and reduce the formation of platelets. Platelets are tiny cells that cluster about an area of damaged artery. A cluster of platelets contributes to a narrow artery.
4) help stabilize plaque, plaque is somewhat like a scab on a cut. In the artery plaque can become loose and move down an artery causing blockage.
5) have anti-thrombotic effects, help prevent blood clots (thrombus) from forming in blood vessels.
Source: Beneficial Cardiovascular Pleiotropic Effects of Statins,
Jean Davignon, MD
Menopause is established when a woman around age fifty has not had a menstrual period in twelve months. It is beneficial for women at menopause to have blood work taken (lipid profile) that includes HDL and LDL cholesterol, total cholesterol, triglycerides, Apo-B, LDL subclass, *HDL subclass, Lp(a), homocysteine and C reactive protein levels. An assessment of this lipid profile can help reduce the risk and lessen the occurrence of postmenopausal heart disease.
*There are five subgroups of high density lipoproteins HDL, and seven subgroups of low density lipoproteins LDL that can provide information regarding the health of the arteries. For information about the Menopausal Transition and irregular heart beat click here. Source:
American Family Physician Vol. 67/No. 6 (March 15, 2003)
Richard Sadovsky, M.D
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CardioE2 . . . For Her Heart, Inc is a nonprofit organization # 900000216 registered and based in Florida, USA. “Ownership and Rights. CardioE2 Inc., the parent of Vascular Events shall own all and exclusive right, title, and interest in the work throughout the world, including copyrights, domain names, trademarks, and all other intellectual property rights in the work. The work shall be deemed to be a work-for-hire under the Copyright Act of 1976, Title 17 U.S.Code, and Ann Williams/Vascular Events Inc., shall be deemed to be the author.” | Information is provided for educational purposes to help individuals form an understanding of biological processes as they effect health. This information is not intended for medical diagnosis or treatment. |
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