Division of Cardiology,
UCSF Medical Center,
Codirector, Center of Excellence for Women,
San Francisco, Calif
A recent survey commissioned by the American Heart Association
found that only 7% of all women identify heart disease as their
greatest health threat, despite the fact that it is actually the
leading cause of death in women. With increasing awareness in the
medical as well as the lay community of the major role
cardiovascular disease plays in morbidity and mortality
of women, there has been mounting attention to gender differences in
cardiovascular disease. It is striking that heart
disease does not begin to appear in noticeable numbers in women until
after menopause, a fact that stimulates discussion and investigation of
the role of estrogen in warding off the ravages of
atherosclerosis. This book is a comprehensive and
scholarly discussion of the current state of knowledge of possible
mechanisms for interaction between estrogen and
cardiovascular disease in women.
Although it has been known for some time that estrogen regulates
lipoprotein binding and clearance by the liver with a favorable effect
on the lipid profile, it has also been clear that the
hypocholesterolemic effect of estrogen accounts for
less than half of its associated cardiac risk reduction. Other possible
mechanisms are explored in fascinating detail in this monograph, such
as the antioxidant properties of estrogen, the effect of estrogen on
the composition of connective tissue molecules, the effect of estrogen
on inhibiting monocyte differentiation into macrophages, and
the role of estrogen in regulating vascular cell proliferation at both
the level of smooth muscle proliferation and collagen and elastin
synthesis. The book
© 1998 American Heart Association, Inc.
Book Reviews
Hormonal, Metabolic, and Cellular Influences on Cardiovascular Disease in Women
Trudy M. Forte, PhD. 365 pp. Armonk, NY: Futura Publishing Co Inc;1997. $85.00. ISBN 0-87993-668-1.