Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Estrogen use is associated with protection from cardiovascular disease in postmenopausal women. This benefit appears to be magnified among women with pre-existing heart disease. The possible bias of intrinsically better health in women using estrogen has not been ruled out in observational studies. Therefore, two double-blind randomized clinical trials are underway in postmenopausal women. One in women with coronary disease is known as HERS (Heart Estrogen-progestin Replacement Study) and another in predominantly healthy women is the WHI (Women's Health Initiative). Several mechanisms of estrogen mediated protection from cardiovascular disease have been identified including increased HDL, lower LDL, lower VLDL-cholesterol/triglyceride ratio, increased clearance of intermediate density lipoprotein (IDL) and LDL via an upregulated LDL receptor, diminished penetration and degradation of LDL in the arterial wall, an inhibition of LDL oxidation by various estrogens and a reversal of inappropriate acetylcholine (EDRF)-mediated vasoconstriction in arteriosclerotic vessels. The predominating mechanism is not known, but estrogen replacement therapy is both likely to be beneficial to female health, pending randomized trials, as well as a tool to understand mechanisms of prevention of coronary artery disease.
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PMID:Effects of estrogens on lipoprotein metabolism and cardiovascular disease in women. 785 90

There are no new data in the Women's Health Initiative. The Collaborative Study of Hormone Factors in breast cancer showed a non-significant increased risk after 5 years. HERS showed an increased risk of cardiovascular disease in HT users with previous heart disease. The Cache County study indicated that estrogen therapy initiated after age 60 increased the incidence of Alzheimer's disease. The daily progestogen in the HT users decreased the estrogen receptors in the coronary arteries and minimized the beneficial direct effect of estrogen. It also decreased progesterone receptors in the endometrium, thus making it less endometrial-protective. The WHI was contrary to previous studies of estrogen therapy because women with specific menopausal symptoms were excluded, were older, had never used estrogen and had long-term estrogen deficiency. It takes healthy tissue to allow an effective response to estrogen and maintenance of health. Maximal benefit of HT may require early onset of treatment, near the time of menopause. However, it is never too late to arrest the progression of osteoporosis and decrease the risk of fracture.
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PMID:The women's health initiative reports in perspective: facts or fallacies? 1566 45

The development of the understanding of the underlying causes of coronary heart disease has undergone several stages. Ecological studies, such as the Seven Countries' Study, showed a possible relationship between mortality in coronary heart disease and intake of saturated fats. The investigated area with the lowest rates of cardiovascular disease was the island of Crete, Greece. A discussion soon started to evolve around the Mediterranean diet, which at the time consisted of mainly foods of vegetable origin, olive oil and cereals of unrefined nature. Several clinical trials have been undertaken since, including the Lyon Heart Diet Study where it was clearly shown that both mortality and morbidity in coronary heart disease was substantially lowered by Mediterranean food compared to controls. Dean Ornish proved that an extreme regimen actually could reduce already existing sclerotic plaques, while the WHI study showed that a more modest diet change diet not cause the intended reduction in heart disease in middle-aged women. Another prospective study of a similar age group of women showed that a diet with a low glycemic load gave a good reduction in coronary heart disease. Multiple studies of different components of food have shown no positive result, pointing at the whole diet rather than its components of nutrients being of importance. Today, the experts agree on the optimal diet to prevent not only heart disease but also cancer forms and other chronic disease such as type 2 diabetes mellitus. This diet is consisting of a lot of fruit and vegetables, lots of fish, less salt and sugar, more unrefined cereals, beans and nuts. Going from a general notion of Mediterranean food to testing that food in clinical settings and testing nutrients as preventative agents, we can conclude that a generally healthy lifestyle, including a healthy diet, appropriate amounts of physical activity, good sleep and less stress, is the way to a heart healthy life.
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PMID:A Historical Perspective of the Understanding of the Link between Diet and Coronary Heart Disease. 2004 57