 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
15 March 1993 | Volume 118 Issue 6 | Pages 429-432
Objective: To determine whether a sex-associated difference in endothelin levels exists and to assess whether this difference is mediated by sex hormones.
Design: Initial survey in healthy persons, followed by a nonrandomized intervention.
Setting: A university teaching hospital.
Patients: Twenty-three healthy men, 29 healthy women, 20 pregnant women, and 12 male-to-female and 13 female-to-male transsexual patients.
Measurements: Plasma levels of endothelin were first assessed in healthy men, healthy women, and pregnant women; subsequently, endothelin levels were determined in male-to-female and female-to-male transsexual patients both before and during cross-gender hormone treatment. This treatment involves administration of testosterone esters to women and of ethynylestradiol and cyproterone acetate to men.
Results: Endothelin levels were higher in men than in women (5.9 ± 1.2 compared with 4.17 ± 0.67 pg/mL; P < 0.01). Endothelin levels were lower in pregnant women than in age- and sex-matched nonpregnant controls (2.19 ± 0.73 compared with 4.17 ± 0.67 pg/mL; P < 0.01). In 12 male-to-female transsexuals treated with estradiol and the progestational agent cyproterone acetate, endothelin levels decreased from 8.1 ± 3.0 to 5.1 ± 2.0 pg/mL (P < 0.01). In 13 female-to-male transsexuals treated with testosterone, endothelin levels increased from 6.2 ± 1.1 to 7.8 ± 1.2 pg/mL (P < 0.01).
Conclusion: Sex hormones may modulate plasma endothelin levels, with male hormones raising levels and female hormones lowering them. This finding may be important in explaining sex-associated differences in susceptibility to atherosclerotic cardiovascular disease.
Endothelial cells synthesize many active substances that regulate local blood pressure and maintain the fluidity of blood and the patency of blood vessels [7]. These include vasodilators such as endothelium-derived relaxing factor and prostacyclin (which also inhibit platelet adhesion and aggregation), vasoconstrictors such as endothelin, and larger molecules such as fibronectin. Endothelin may also have mitogenic properties [7, 8]. The release of these substances affects the local environment in the blood vessel; endothelin may also have a systemic function [7]. Some evidence has emerged that endothelin may be involved in the pathogenesis of hypertension [7, 9] and atherosclerosis [10]. Elevated plasma levels of endothelin have been observed in patients with myocardial infarction and diabetes. Whether sex hormones have direct effects on the endothelium is not known.
We found that plasma endothelin levels tended to be higher in men than in women and lower in pregnant women than in nonpregnant controls. These considerations prompted us to compare endothelin levels in healthy young men and women and to assess the effects of long-term sex hormone therapy in male-to-female and female-to-male transsexuals on plasma endothelin levels.
All patients were within 10% of their ideal body weight (Metropolitan Life Insurance Tables, 1959). None had a personal or family history of diabetes or hypertension or had evidence of cardiovascular disease on routine examination (medical history, physical examination, and electrocardiogram). No hormone preparations (such as oral contraceptives) had been used by any of the participants in the 6 months before the study. All women had a regular menstrual cycle (28 to 31 days) before hormone treatment; blood samples were drawn during the follicular phase of the menstrual cycle (days 3 to 5).
Female-to-male transsexuals received intramuscular injections of testosterone esters (Sustanon, Organon, Oss, the Netherlands), 250 mg every 2 weeks. Male-to-female transsexuals received oral ethynylestradiol (Lynoral, Organon), 0.1 mg/d, and cyproterone acetate (Androcur, Schering, Weesp, the Netherlands), 100 mg/d, to counteract the effects of testosterone.
Plasma endothelin levels were measured before therapy and after 4 months of hormone use. Blood samples were drawn between 0900 hours and 0930 hours after an overnight fast, patients having rested in the supine position for at least 30 minutes. Samples were immediately placed in ice. Testosterone levels were determined 10 to 14 days after injection, and blood samples were drawn simultaneously with those in which plasma endothelin levels were determined.
Plasma was separated within 1 hour and then stored at –20°C until assayed. Plasma endothelin was measured by radioimmunoassay (Nichols Institute [formerly ITS], Wijchen, the Netherlands) after extraction on Sep-Pak C18 cartridges (Waters, Milford, Massachusetts), as described previously [17]. Recovery rate for this assay is 92.4%. Intra-assay and interassay coefficients of variation according to the manufacturer are 2.4% and 4.2%, respectively. (We found these values to be slightly higher: 3.6% and 5.1%, respectively.) Sensitivity of the assay is 1 pg/mL; cross-reactivity with endothelin-2 is 52%; with endothelin-3, 96%; and with "big" endothelin, 7%. Intra-assay variation ranged from 2% to 8%, and interassay variation ranged from 4% to 9%.
In all patients, blood pressure was determined during a 2-hour period using an automatic sphygmomanometer; patients remained at rest during this period. Blood pressure measurements were done every 5 minutes, and the results were averaged.
Results are expressed as mean ±SD. The Student two-tailed t-test for paired data was used to compare measurements within the same group before and during hormone therapy. The Student two-tailed unpaired t-test was used for between-group comparisons. A P value of less than 0.05 was considered statistically significant. ARTICLE
Influence of Sex Hormones on Plasma Endothelin Levels
Atherosclerosis and hypertension are more common in men than in women, a difference that may be due, in part, to the actions of their respective sex hormones. Men have more atherogenic lipid profiles than women, and sex hormones play an important role in the development of this difference [1-3]. In addition, some evidence has emerged that androgens can induce insulin resistance [3, 4]; several case reports describe cardiovascular events in young persons after the use of anabolic steroids [5, 6]. Sex hormone-associated differences in lipid profiles and insulin sensitivity may partly explain why premenopausal women are relatively protected against cardiovascular disease. It remains to be determined, however, whether the difference between men and age-matched women in the incidence of atherosclerosis can be explained by differences in lipid profiles and insulin sensitivity alone or whether other mechanisms might be involved.
Methods
Top
Methods
Results
Discussion
Author & Article Info
References
We measured endothelin levels in 29 healthy young women (18 to 31 years of age; mean age, 24.1 years), 20 pregnant women (20 to 32 years of age; mean age, 26.3 years), and 23 healthy men (23 to 33 years of age; mean age, 24.7 years). To assess the effects of sex hormone therapy on plasma levels of endothelin, we measured endothelin levels before and during sex hormone therapy in 12 male-to-female transsexual patients (17 to 33 years of age; mean age, 28.4 years) and 13 female-to-male transsexual patients (17 to 26 years of age; mean age, 24.4 years). Informed consent was obtained from all participants, and the study was approved by the hospital ethics committee.
Results
Top
Methods
Results
Discussion
Author & Article Info
References
Plasma endothelin levels were significantly higher in men than in women (5.9 ± 1.2 compared with 4.17 ± 0.67 pg/mL; P < 0.01). Endothelin levels were lower in pregnant women than in nonpregnant controls (2.19 ± 0.73 compared with 4.17 ± 0.67 pg/mL; P < 0.01), suggesting that high levels of estradiol and progesterone found during pregnancy are associated with low endothelin levels (Figure 1).
|
In biological women treated with intramuscular injections of testosterone esters, basal testosterone levels increased from 1.25 ± 0.66 nmol/L to 24.8 ± 13.0 nmol/L (P < 0.01). No significant change was seen in levels of estradiol-17 ß (247 ± 207 compared with 185 ± 94 pmol/L). Biological men were treated with oral ethynylestradiol, 0.1 mg/d, and cyproterone acetate, 100 mg/d. Testosterone levels decreased from 18.4 ± 8.6 to 1.1 ± 0.4 nmol/L in this group (P < 0.01). Levels of estradiol-17 ß and ethynylestradiol were not assessed. The biological effects of sex hormone therapy were manifest in both groups.
Effects of sex hormone therapy on endothelin levels in both groups are shown in Figure 2. Endothelin levels before treatment tended to be higher in men than in women (8.1 ± 3.1 compared with 6.2 ± 1.1 pg/mL; P = 0.06), confirming our earlier observations. In biological women treated with testosterone, average endothelin levels increased from 6.2 ± 1.1 to 7.8 ± 1.2 pg/mL (P < 0.01) after 4 months of therapy. In men treated with estradiol and cyproterone acetate, endothelin levels decreased from 8.1 ± 3.0 to 5.1 ± 2.0 pg/mL (P < 0.01). Thus, the decrease in endothelin levels in men was greater than the increase in women treated with testosterone (37% and 26%, respectively); antiandrogenic actions of cyproterone acetate may have contributed to the decrease in endothelin levels in men.
|
Blood pressure was measured in all participants (at rest) during a 2-hour period before and during hormone therapy. No significant alterations were seen; mean systolic and diastolic pressures were unchanged.
To investigate the variability of endothelin plasma levels, we measured endothelin levels twice within a period of 2 months in 10 normal men. Endothelin levels were 5.90 ± 0.85 pg/mL at the first measurement and 5.85 ± 1.05 pg/mL at the second measurement (P 
0.05), the coefficient of variation being 16.2%. These data suggest that endothelin levels are relatively stable over a period of several months.
Discussion
|
|---|
|
TopMethodsResultsDiscussionAuthor & Article InfoReferences |
|---|
Atherosclerosis is characterized by endothelial injury and the proliferation of intimal smooth-muscle cells, which may be a result of the release of growth factors from the vessel wall [11]. The evidence suggests that endothelin, which is a strong vasoconstrictor, also has mitogenic properties [7, 8]. A correlation between endothelin levels and atherosclerosis has been described [10], suggesting that endothelin might participate in atherogenesis. Thus, if sex hormones affect levels of endothelin, this might be one of the mechanisms by which sex hormones influence the risk for cardiovascular disease. We speculate that a sex-associated difference in levels of endothelin may be one of the mechanisms underlying the difference in the incidence of cardiovascular disease between men and women.
In our patients, blood pressure did not change during hormonal treatment. Asscheman and colleagues [12] assessed blood pressure in 425 transsexual patients (303 biological men and 122 biological women) receiving long-term sex hormone therapy. High blood pressure developed in 10 biological men treated with estrogens (2.4% of the total group of 425 patients) and in none of the women treated with testosterone. Studies of the effect of estrogen therapy on blood pressure in postmenopausal women [13, 14] and in women using oral contraceptives [15] have produced conflicting results. Thus, the effect of sex hormone therapy on blood pressure remains unclear. In healthy men, the intravenous administration of endothelin induces an increase in blood pressure and serum potassium level when endothelin levels are increased four to ten times [16]. Thus, the increase in endothelin levels observed in our patients may have been too small to increase systemic vascular resistance and blood pressure. Alternatively, any such effect may have been offset by counter-regulatory forces that were not assessed in our study.
We conclude that administration of pharmacologic doses of androgens and estrogens induces changes in plasma endothelin levels. Our results indicate that the differences in sex steroid levels between the sexes may play a role in the regulation of local factors implicated in atherogenesis. We speculate that, by such mechanisms, androgens may have deleterious effects on the endothelial wall, whereas estrogens may enhance protective mechanisms.
Author and Article Information
|
|---|
|
TopMethodsResultsDiscussionAuthor & Article InfoReferences |
|---|
References
|
|---|
|
TopMethodsResultsDiscussionAuthor & Article InfoReferences |
|---|
1. Mooradian AD, Morley JE, Korenman SG. Biological actions of androgens. Endocr Rev. 1987; 8:1-28.
2. Knopp RH. Cardiovascular effects of endogenous and exogenous sex hormones over a woman's lifetime. Am J Obstet Gynecol. 1988; 158:1630-43.
3. Gooren LJ, Polderman KH. Safety aspects of androgen therapy. In: Nieschlag E, Behre HM, eds. Testosterone: Action, Deficiency, Substitution. Heidelberg: Springer Verlag; 1990:182-203.
4. Cohen JC, Hickman R. Insulin resistance and diminished glucose tolerance in powerlifters ingesting anabolic steroids. J Clin Endocrinol Metab. 1987; 64:960-3.
5. Nagelberg SB, Laue L, Loriaux DL, Lin L, Sherins RJ. Cerebrovascular accident associated with testosterone therapy in a 20-year old hypogonadal man (Letter). N Engl J Med. 1986; 314:649-50.
6. McNut RA, Ferenchick GS, Kirlin PC, Hamlin NJ. Acute myocardial infarction in a 22-year old world class weight lifter using anabolic steroids. Am J Cardiol. 1988; 62:164.
7. Vane JR, Anggangstromrd EE, Botting RM. Mechanisms of disease: regulatory functions of the vascular endothelium. N Engl J Med. 1990; 323:27-36.
8. Hirata Y, Takagi Y, Fukuda Y, Marumo F. Endothelin is a potent mitogen for rat vascular smooth muscle cells. Atherosclerosis. 1989; 78:225-8.
9. Kohno M, Yasunari K, Murakawa KI, Yokokawa K, Horio T, Fukui T, et al. Plasma immunoreactive endothelin in essential hypertension. Am J Med. 1990; 88:614-8.
10. Lerman A, Edwards BS, Hallett JW, Heublein DM, Sandberg SM, Burnett JC Jr. Circulating and tissue endothelin immunoreactivity in advanced atherosclerosis. N Engl J Med. 1991; 325:997-1001.
11. Ross R. The pathogenesis of atherosclerosis—-an update. N Engl J Med. 1986; 314:488-500.
12. Asscheman H, Gooren LJ, Eklund PL. Mortality and morbidity in transsexual patients with cross-gender hormone treatment. Metabolism. 1989; 38:869-73.
13. Wren BG, Brown LB, Routledge DA. Differential clinical response to estrogens after menopause. Med J Aust. 1982; 2:329-32.
14. Lind T, Cameron EC, Hunter WM, Leon C, Moran PF, Oxley A, et al. A prospective, controlled trial of six forms of hormone replacement therapy given to postmenopausal women. Br J Obstet Gynaecol. 1979; 86(Suppl):1-29.
15. Stadel BV. Oral contraceptives and cardiovascular disease. N Engl J Med. 1981; 305:612-8, and 672-7.
16. Vierhapper H, Wagner O, Nowotny P, Waldhausl W. Effect of endothelin-l in man. Circulation. 1990; 81:1415-8.
17. Voerman HJ, Stehouwer CD, van Kamp GJ, Strack van Schijndel RJ, Groeneveld AB, Thijs LG. Plasma endothelin levels are increased during septic shock. Crit Care Med. 1992; 20:1097-101.
This article has been cited by other articles:
|
|
 |
|
  P. D. Patel and R. R. Arora Review: Endothelial dysfunction: A potential tool in gender related cardiovascular disease Therapeutic Advances in Cardiovascular Disease, April 1, 2008; 2(2): 89 - 100. [Abstract] [PDF]
|
|
|
|
 |
|
 J. R. Meendering, B. N. Torgrimson, N. P. Miller, P. F. Kaplan, and C. T. Minson Estrogen, medroxyprogesterone acetate, endothelial function, and biomarkers of cardiovascular risk in young women Am J Physiol Heart Circ Physiol, April 1, 2008; 294(4): H1630 - H1637. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Kher, K. K. Meldrum, M. Wang, B. M. Tsai, J. M. Pitcher, and D. R. Meldrum Cellular and molecular mechanisms of sex differences in renal ischemia-reperfusion injury Cardiovasc Res, September 1, 2005; 67(4): 594 - 603. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Dong, X. Wang, H. Zhu, F. A. Treiber, and H. Snieder Endothelin-1 Gene and Progression of Blood Pressure and Left Ventricular Mass: Longitudinal Findings in Youth Hypertension, December 1, 2004; 44(6): 884 - 890. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. W. Ryan, N. J. Vogelzang, E. E. Vokes, H. L. Kindler, S. D. Undevia, R. Humerickhouse, A. K. Andre, Q. Wang, R. A. Carr, and M. J. Ratain Dose-Ranging Study of the Safety and Pharmacokinetics of Atrasentan in Patients with Refractory Malignancies Clin. Cancer Res., July 1, 2004; 10(13): 4406 - 4411. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Orshal and R. A. Khalil Gender, sex hormones, and vascular tone Am J Physiol Regulatory Integrative Comp Physiol, February 1, 2004; 286(2): R233 - R249. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Iemolo, A. Martiniuk, D. A. Steinman, and J. D. Spence Sex Differences in Carotid Plaque and Stenosis Stroke, February 1, 2004; 35(2): 477 - 481. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Gonzales, D. N. Krause, and S. P. Duckles Testosterone suppresses endothelium-dependent dilation of rat middle cerebral arteries Am J Physiol Heart Circ Physiol, February 1, 2004; 286(2): H552 - H560. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Spence, T. Thornton, A. D. Muir, and N. D. Westcott The Effect of Flax Seed Cultivars with Differing Content of {alpha}-Linolenic Acid and Lignans on Responses to Mental Stress J. Am. Coll. Nutr., December 1, 2003; 22(6): 494 - 501. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Chatrath, K. L. Ronningen, P. LaBreche, S. R. Severson, M. Jayachandran, M. P. Bracamonte, and V. M. Miller Effect of puberty on coronary arteries from female pigs J Appl Physiol, October 1, 2003; 95(4): 1672 - 1680. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Funke-Kaiser, F. Reichenberger, K. Kopke, S.-M. Herrmann, J. Pfeifer, H.-D. Orzechowski, W. Zidek, M. Paul, and E. Brand Differential binding of transcription factor E2F-2 to the endothelin-converting enzyme-1b promoter affects blood pressure regulation Hum. Mol. Genet., February 15, 2003; 12(4): 423 - 433. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. A. Treiber, G. K. Kapuku, H. Davis, J. S. Pollock, and D. M. Pollock Plasma Endothelin-1 Release During Acute Stress: Role of Ethnicity and Sex Psychosom Med, September 1, 2002; 64(5): 707 - 713. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I.-s. Kim, H.B. Siril Ariyaratne, and S.M.L. C. Mendis-Handagama Changes in the Testis Interstitium of Brown Norway Rats with Aging and Effects of Luteinizing and Thyroid Hormones on the Aged Testes in Enhancing the Steroidogenic Potential Biol Reprod, May 1, 2002; 66(5): 1359 - 1366. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Senanarong, S. Vannasaeng, N. Poungvarin, S. Ploybutr, S. Udompunthurak, P. Jamjumras, L. Fairbanks, and J. L. Cummings Endogenous Estradiol in Elderly Individuals: Cognitive and Noncognitive Associations Arch Neurol, March 1, 2002; 59(3): 385 - 389. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Lewis, M. P. Bracamonte, K. S. Rud, and V. M. Miller Genome and Hormones: Gender Differences in Physiology: Selected Contribution: Effects of sex and ovariectomy on responses to platelets in porcine femoral veins J Appl Physiol, December 1, 2001; 91(6): 2823 - 2830. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Zhang, S. Seshadri, R. C. Ellison, T. Heeren, and D. T. Felson Bone Mineral Density and Verbal Memory Impairment: Third National Health and Nutrition Examination Survey Am. J. Epidemiol., November 1, 2001; 154(9): 795 - 802. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. L. David, M. H. C. Carvalho, A. L.N. Cobra, D. Nigro, Z. B. Fortes, N. A. Reboucas, and R. C.A. Tostes Ovarian Hormones Modulate Endothelin-1 Vascular Reactivity and mRNA Expression in DOCA-Salt Hypertensive Rats Hypertension, September 1, 2001; 38(3): 692 - 696. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Vermeulen Androgen Replacement Therapy in the Aging Male--A Critical Evaluation J. Clin. Endocrinol. Metab., June 1, 2001; 86(6): 2380 - 2390. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Sanada, Y. Higashi, K. Nakagawa, S. Sasaki, I. Kodama, M. Tsuda, N. Nagai, and K. Ohama Relationship between the angiotensin-converting enzyme genotype and the forearm vasodilator response to estrogen replacement therapy in postmenopausal women J. Am. Coll. Cardiol., May 1, 2001; 37(6): 1529 - 1535. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Wise, D. B. Dubal, M. E. Wilson, S. W. Rau, and M. Bottner Minireview: Neuroprotective Effects of Estrogen--New Insights into Mechanisms of Action Endocrinology, March 1, 2001; 142(3): 969 - 973. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. W. Smith, O. Ornatsky, D. J. Stewart, P. Picard, F. Dawood, W.-H. Wen, P. P. Liu, D. J. Webb, and J. C. Monge Effects of Estrogen Replacement on Infarct Size, Cardiac Remodeling, and the Endothelin System After Myocardial Infarction in Ovariectomized Rats Circulation, December 12, 2000; 102(24): 2983 - 2989. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. G. Geary, D. N. Krause, and S. P. Duckles Gonadal hormones affect diameter of male rat cerebral arteries through endothelium-dependent mechanisms Am J Physiol Heart Circ Physiol, August 1, 2000; 279(2): H610 - H618. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A.S. Bilsel, H. Moini, E. Tetik, F. Aksungar, B. Kaynak, and A. Ozer 17{beta}-Estradiol modulates endothelin-1 expression and release in human endothelial cells Cardiovasc Res, June 1, 2000; 46(3): 579 - 584. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Wight, C. F. Kung, P. Moreau, H. Takase, N. A. Bersinger, and T. F. Luscher Aging, Serum Estradiol Levels, and Pregnancy Differentially Affect Vascular Reactivity of the Rat Uterine Artery Reproductive Sciences, March 1, 2000; 7(2): 106 - 113. [Abstract] [PDF]
|
|
|
|
|
|
E. Haapaniemi, T. Tatlisumak, K. Hamel, L. Soinne, C. Lanni, T. J. Opgenorth, and M. Kaste Plasma Endothelin-1 Levels Neither Increase nor Correlate With Neurological Scores, Stroke Risk Factors, or Outcome in Patients With Ischemic Stroke Stroke, March 1, 2000; 31(3): 720 - 725. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Hugel, M. Reincke, H. Stromer, J. Winning, M. Horn, C. Dienesch, P. Mora, H. H. H. W. Schmidt, B. Allolio, and S. Neubauer Evidence against a role of physiological concentrations of estrogen in post-myocardial infarction remodeling J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1427 - 1434. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Barrett-Connor, D. Goodman-Gruen, and B. Patay Endogenous Sex Hormones and Cognitive Function in Older Men J. Clin. Endocrinol. Metab., October 1, 1999; 84(10): 3681 - 3685. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Plonowski, A. K.Kaplinski, M. Radzikowska, M. Borowiec, and B. Baranowska Correlation between 21 amino acid endothelin, intrafollicular steroids and follicle size in stimulated cycles Hum. Reprod., September 1, 1999; 14(9): 2323 - 2327. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V M Miller Gender and vascular reactivity Lupus, June 1, 1999; 8(5): 409 - 415. [Abstract] [PDF]
|
|
|
|
|
|
C. Stefanadis, E. Tsiamis, J. Dernellis, and P. Toutouzas Effect of estrogen on aortic function in postmenopausal women Am J Physiol Heart Circ Physiol, February 1, 1999; 276(2): H658 - H662. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. M. White, R. E. McCullough, R. Dyckes, A. D. Robertson, and L. G. Moore Effects of pregnancy and chronic hypoxia on contractile responsiveness to alpha 1-adrenergic stimulation J Appl Physiol, December 1, 1998; 85(6): 2322 - 2329. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Bagatell and W. J. Bremner V. The Effects of Aging and Testosterone on Lipids and Cardiovascular Risk J. Clin. Endocrinol. Metab., October 1, 1998; 83(10): 3440 - 3441. [Full Text]
|
|
|
|
|
|
K. Sudhir, E. Ko, C. Zellner, H. E. Wong, S. J. Hutchison, T. M. Chou, and K. Chatterjee Physiological Concentrations of Estradiol Attenuate Endothelin 1–Induced Coronary Vasoconstriction In Vivo Circulation, November 18, 1997; 96(10): 3626 - 3632. [Abstract] [Full Text]
|
|
|
|
|
|
V. Guetta, A. A. Quyyumi, A. Prasad, J. A. Panza, M. Waclawiw, and R. O. Cannon III The Role of Nitric Oxide in Coronary Vascular Effects of Estrogen in Postmenopausal Women Circulation, November 4, 1997; 96(9): 2795 - 2801. [Abstract] [Full Text]
|
|
|
|
|
|
X. Wang, D. A. Barber, D. A. Lewis, C. G. A. McGregor, G. C. Sieck, L. A. Fitzpatrick, and V. M. Miller Gender and transcriptional regulation of NO synthase and ET-1 in porcine aortic endothelial cells Am J Physiol Heart Circ Physiol, October 1, 1997; 273(4): H1962 - H1967. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. D. L. Fisher, C. Ferri, C. Bellini, A. Santucci, R. Gleason, G. H. Williams, N. K. Hollenberg, and E. W. Seely Age, Gender, and Non-modulation : A Sexual Dimorphism in Essential Hypertension Hypertension, April 1, 1997; 29(4): 980 - 985. [Abstract] [Full Text]
|
|
|
|
|
|
M. Lockshin Occasional Series Why women? Lupus, January 1, 1997; 6(8): 625 - 632. [PDF]
|
|
|
|
|
|
S. Pinto, A. Virdis, L. Ghiadoni, G. Bernini, M. Lombardo, F. Petraglia, A. R. Genazzani, S. Taddei, and A. Salvetti Endogenous Estrogen and Acetylcholine-Induced Vasodilation in Normotensive Women Hypertension, January 1, 1997; 29(1): 268 - 273. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Ergul, D. C. Parish, D. Puett, and A. Ergul Racial Differences in Plasma Endothelin-1 Concentrations in Individuals With Essential Hypertension Hypertension, October 1, 1996; 28(4): 652 - 655. [Abstract] [Full Text]
|
|
|
|
|
|
V. Guetta and R. O. Cannon III Cardiovascular Effects of Estrogen and Lipid-Lowering Therapies in Postmenopausal Women Circulation, May 15, 1996; 93(10): 1928 - 1937. [Full Text]
|
|
|
|
|
|
J. Alfie, G. D. Waisman, C. R. Galarza, M. I. Magi, F. Vasvari, L. M. Mayorga, and M. I. Camera Relationship Between Systemic Hemodynamics and Ambulatory Blood Pressure Level Are Sex Dependent Hypertension, December 1, 1995; 26(6): 1195 - 1199. [Abstract] [Full Text]
|
|
|
|
|
|
P. Collins, G. M. C. Rosano, P. M. Sarrel, L. Ulrich, S. Adamopoulos, C. M. Beale, J. G. McNeill, and P. A. Poole-Wilson 17ß-Estradiol Attenuates Acetylcholine-Induced Coronary Arterial Constriction in Women but Not Men With Coronary Heart Disease Circulation, July 1, 1995; 92(1): 24 - 30. [Abstract] [Full Text]
|
|
|
Article
