2019 年 89 巻 4 号 p. 73-82
Differences in cardiovascular disease are found between the genders. In women, it is known that estrogen has both indirect and direct protective effects on the cardiovascular system. This includes a decrease in low-density lipoprotein cholesterol (LDL-C), an increase in high-density lipoprotein cholesterol (HDL-C), the vasodilatation response by endothelial Nitric Oxide Synthase (eNOS) synthase, and prostacyclin synthesis.
Many cases of coronary spastic angina and acute coronary syndrome (ACS) have been observed during the menstrual and the late luteal phases of the menstrual cycle, corresponding with low levels of estrogen. After menopause, the risk of atherosclerosis and associated conditions such as; dyslipidemia, hypertension, obesity, diabetes, T cell activation, and adhesion molecules, increase. Consequently, the risk of a cardiovascular event also increases. In addition, regarding the pathological mechanism underlying ACS, erosion is observed most prominently during pre-menopause, whereas plaque rupture is observed in post-menopause.
Furthermore, microvascular angina is often found in menopausal women displaying various symptoms, thus a diagnosis may be difficult. We recognize a decrease in vascular endothelial function and the coronary flow reserve and a high level of lactic acid in the coronary sinus as diagnostic criteria. Regarding problems associated with the "super-aging" society, there are many elderly female patients with HFpEF (heart failure with preserved ejection fraction) who have diastolic dysfunction. Also well-known are cases of atherosclerosis and osteoporosis progressed by common risk factors, and recently, vascular bone disease.
There are characteristics in women for microvascular angina and heart failure, as well as ischemic heart disease, due to atherosclerosis caused by the sex hormone environment in later life stages. Considering gender-specific medicine in the prevention and treatment of cardiovascular disease is important for healthy aging of women.