EFFECTS OF ESTROGEN ON CORONARY ARTERY CALCIFICATION AND THE RELATIONSHIP BETWEEN OSTEOPOROSIS AND CARDIOVASCULAR DISEASES IN POSTMENOPAUSAL WOMEN

Year 2021, Volume: 8 Issue: 3, 99 - 102, 01.10.2021

Alican Güvenç , Ceren Yılmaz Buse Balta Zeynep Yıldız Selma Arzu Vardar

Abstract

Estrogen deficiency is known to be one of the causes of cardiovascular disease and osteoporosis in postmenopausal women. Coronary artery calcification is one of the major factors of cardiovascular disease. The studies related to the effects of estrogen on coronary artery calcification and the possible relation between osteoporosis and cardiovascular disease rapidly increased in recent years. Estrogen levels decrease in postmenopausal women and can lead to an increased risk of cardiovascular disease. Estrogen could affect cardiovascular diseases by mediating the receptor activator of nuclear factor-kappa B ligand-osteoprotegerin system in vascular smooth muscle cells and autophagy in cardiomyocytes. Current evidence indicates that estrogen has an increasing effect on bone mineral density by multiple biochemical pathways: increasing calcium absorption in the gastrointestinal system, decreasing excretion of calcium in the kidneys, reducing bone resorption, such as enchanting osteoblasts, suppressing osteoclasts by inhibiting proinflammatory cytokines, and inhibiting the activity of osteoclasts by essentially inhibiting the receptor activator of nuclear factor-kappa B ligand-osteoprotegerin system. Recent studies showed a significant relationship between coronary artery calcification and osteoporosis due to estrogen’s role in these pathogeneses, which can be prevented by using estrogen hormone therapy for post- menopausal women. In this review, we focused on the molecular mechanisms of estrogen in the development of coronary artery calcification and osteoporosis and the effects of estrogen hormone therapy on cardiovascular diseases in postmenopausal women.

Keywords

Menopause, osteoporosis, vascular calcification, estrogen replacement therapy, cardiovascular diseases

References

• 1. Liu W, Zhang Y, Yu CM et al. Current understanding of coronary artery calcifica- tion. J Geriatr Cardiol 2015;12(6):668-75.
• 2. Criqui MH, Denenberg JO, Ix JH et al. Calcium density of coronary artery plaque and risk of incident cardiovascular events. J Am Med Assoc 2014;311(3):271-8.
• 3. Herrema H, Nieuwdorp M, Groen AK. Microbiome and cardiovascular disease. In: Handbook of Experimental Pharmacology. Berlin, Heidelberg: Springer; 2020.p.1-24.
• 4. Okamura A, Rakugi H, Ohishi M et al. Upregulation of renin-angiotensin system during differentiation of monocytes to macrophages. J Hypertens 1999;17(4):537- 45.
• 5. Thomas H, Diamond J, Vieco A et al. Global atlas of cardiovascular disease 2000- 2016: the path to prevention and control. Glob Heart 2018;13(3):143-63.
• 6. Armas LAG, Recker RR. Pathophysiology of osteoporosis: new mechanistic in- sights. Endocrinol Metab Clin North Am 2012;41(3):475-86.
• 7. Lane JM, Russell L, Khan SN. Osteoporosis. Clin Orthop Relat Res 2000;(372):139- 50.
• 8. Christian RC, Harrington S, Edwards WD et al. Estrogen status correlates with the calcium content of coronary atherosclerotic plaques in women. J Clin Endo- crinol Metab 2002;87(3):1062-7.
• 9. Jin HY, Weir-McCall JR, Leipsic JA et al. The relationship between coronary cal- cification and the natural history of coronary artery disease. JACC Cardiovasc Imaging 2021;14(1):233-42.
• 10. Mohan J, Bhatti K, Tawney A et al. Coronary artery calcification. [Updated 2021 Aug 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: URL: https://www.ncbi.nlm.nih.gov/books/NBK519037/.
• 11. Bakhireva LN, Laughlin GA, Bettencourt R et al. Does osteoprotegerin or receptor activator of nuclear factor-kappa B ligand mediate the association between bone and coronary artery calcification. J Clin Endocrinol Metab 2008;93(5):2009-12.
• 12. Osako MK, Nakagami H, Koibuchi N et al. Estrogen inhibits vascular calcification via vascular RANKL system: common mechanism of osteoporosis and vascular calcification. Circ Res 2010;107(4):466-75.
• 13. El Khoudary SR, Zhao Q, Venugopal V et al. Effects of hormone therapy on heart fat and coronary artery calcification progression: secondary analysis from the KEEPS trial. J Am Heart Assoc 2019;8(15):e012763.
• 14. Peng YQ, Xiong D, Lin X et al. Oestrogen inhibits arterial calcification by promot- ing autophagy. Sci Rep 2017;7(1):3549.
• 15. Jiao L, Machuki JO, Wu Q et al. Estrogen and calcium handling proteins: new discoveries and mechanisms in cardiovascular diseases. Am J Physiol Heart Circ Physiol 2020;318(4):H820-9.
• 16. Stevenson JC. Does estrogen therapy reduce coronary artery calcification in post- menopausal women? Nat Clin Pract Cardiovasc Med 2007;4(12):654-5.
• 17. Mendelsohn ME, Karas RH. HRT and the young at heart. N Engl J Med 2007;356(25):2639-41.
• 18. Schierbeck LL, Rejnmark L, Tofteng CL et al. Effect of hormone replacement ther- apy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ 2012;345:e6409.
• 19. Manson JE, Allison MA, Rossouw JE et al. Estrogen therapy and coronary-artery calcification. N Engl J Med 2007;356(25):2591-602.
• 20. Akhrass F, Evans AT, Wang Y et al. Hormone replacement therapy is associated with less coronary atherosclerosis in postmenopausal women. J Clin Endocrinol Metab 2003;88(12):5611-4.
• 21. Weinberg N, Young A, Hunter CJ et al. Physical activity, hormone replacement therapy, and the presence of coronary calcium in midlife women. Women Heal 2012;52(5):423-36.
• 22. Mackey RH, Kuller LH, Sutton-tyrrell K. Hormone therapy, lipoprotein subclass- es, and coronary calcification. Arc Intern Med 2005;165(5):510-5.
• 23. Poornima IG, Mackey RH, Allison MA et al. Coronary artery calcification (CAC) and post-trial cardiovascular events and mortality within the Women’s Health Initiative (WHI) estrogen-alone trial. J Am Heart Assoc 2017;6(11):e006887.
• 24. Budoff MJ, Chen GP, Hunter CJ et al. Effects of hormone replacement on progres- sion of electron beam tomography. J Women’s Health 2005;14(5):410-7.
• 25. Bakhireva LN, Barrett-Connor EL, Laughlin GA et al. Differences in association of bone mineral density with coronary artery calcification in men and women: the Rancho Bernardo Study. Menopause 2005;12(6):691-8.
• 26. Shahar E, Burke GL, Cushman M et al. Post menopausal hormones and measures of subclinical atherosclerosis: the multi-ethnic study of atherosclerosis. Preven- tive Medicine 2008;47:38-45.
• 27. Irnaten M, Blanchard-Gutton N, Harvey BJ. Rapid effects of 17β-estradiol on epithelial TRPV6 Ca2+ channel in human T84 colonic cells. Cell Calcium 2008;44(5):441-52.
• 28. Öz OK, Hajibeigi A, Howard K et al. Aromatase deficiency causes altered expres- sion of molecules critical for calcium reabsorption in the kidneys of female mice. J Bone Miner Res 2007;22(12):1893-902.
• 29. Christian RC, Harrington S, Edwards WD et al. Estrogen status correlates with the calcium content of coronary atherosclerotic plaques in women. J Clin Endo- crinol Metab 2002;87(3):1062-7.
• 30. Riggs BL. The mechanisms of estrogen regulation of bone resorption. J Clin Invest 2000;106(10):1203-4.
• 31. Chen X, Wang Z, Duan N et al. Osteoblast-osteoclast interactions. Connect Tis- sue Res 2018;59(2):99-107.
• 32. Siddiqui JA, Swarnkar G, Sharan K et al. 8,8"-Biapigeninyl stimulates osteo- blast functions and inhibits osteoclast and adipocyte functions: osteoprotec- tive action of 8,8"-biapigeninyl in ovariectomized mice. Mol Cell Endocrinol 2010;323(2):256-67.
• 33. Fitzpatrick LA. Gender-related differences in the development of atherosclerosis: studies at the cellular level. Clin Exp Pharmacol Physiol 1996;23(3):267-9.
• 34. Hofbauer LC, Brueck CC, Shanahan CM et al. Vascular calcification and osteo- porosis--from clinical observation towards molecular understanding. Osteoporos Int 2007;18(3):251-9.
• 35. Wu M, Rementer C, Giachelli CM. Challenges in treatment. Calcif Tissue Int 2013;93(4):365-73.
• 36. An WS. Sex hormones impact vascular calcification and fracture in dialysis pa- tients. Kidney Res Clin Pract 2020;39(3):236-8.
• 37. Frye MA, Melton LJ, Bryant SC et al. Osteoporosis and calcification of the aorta. Bone Miner 1992;19(2):185-94.
• 38. Tankó LB, Bagger YZ, Christiansen C. Low bone mineral density in the hip as a marker of advanced atherosclerosis in elderly women. Calcif Tissue Int 2003;73(1):15-20.
• 39. Schulz E, Arfai K, Liu X et al. Aortic calcification and the risk of osteoporosis and fractures. J Clin Endocrinol Metab 2004;89(9):4246-53.
• 40. Manson JE, Allison MA, Rossouw JE et al. Estrogen therapy and coronary-artery calcification. N Engl J Med 2007;356(25):2591-602.
• 41. Choi SH, An JH, Lim S et al. Lower bone mineral density is associated with higher coronary calcification and coronary plaque burdens by multidetector row coro- nary computed tomography in pre- and postmenopausal women. Clin Endocri- nol 2009;71(5):644-51.
• 42. Cauley JA. Estrogen and bone health in men and women. Steroids 2015;99(Part A):11-5.
• 43. Barengolts EI, Herman M, Kukreja SC et al. Osteoporosis and coronary ath- erosclerosis in asymptomatic postmenopausal women. Calcif Tissue Int 1998;62(3):209-13.
• 44. Sinnott B, Syed I, Sevrukov A et al. Coronary calcification and osteoporosis in men and postmenopausal women are independent processes associated with ag- ing. Calcif Tissue Int 2006;78(4):195-202.