Open Access Review

Sex-specific risk of cardiovascular disease and cognitive decline: pregnancy and menopause

Virginia M Miller1*, Vesna D Garovic2, Kejal Kantarci3, Jill N Barnes4, Muthuvel Jayachandran5, Michelle M Mielke6, Michael J Joyner4, Lynne T Shuster7 and Walter A Rocca8

Author Affiliations

1 Departments of Surgery and Physiology and Biomedical Engineering, 200 1st St SW, Rochester, MN 55905, USA

2 Division of Nephrology and Hypertension, 200 1st St SW, Rochester, MN 55905, USA

3 Department of Radiology, 200 1st St SW, Rochester, MN 55905, USA

4 Department of Anesthesiology, 200 1st St SW, Rochester, MN 55905, USA

5 Department of Physiology and Biomedical Engineering, 200 1st St SW, Rochester, MN 55905, USA

6 Department of Health Science Research, Division of Epidemiology, 200 1st St SW, Rochester, MN 55905, USA

7 Department of Internal Medicine, Women’s Health Clinic, 200 1st St SW, Rochester, MN 55905, USA

8 Department of Health Science Research, Division of Epidemiology, and Neurology, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA

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Biology of Sex Differences 2013, 4:6  doi:10.1186/2042-6410-4-6

Published: 28 March 2013

Abstract

Understanding the biology of sex differences is integral to personalized medicine. Cardiovascular disease and cognitive decline are two related conditions, with distinct sex differences in morbidity and clinical manifestations, response to treatments, and mortality. Although mortality from all-cause cardiovascular diseases has declined in women over the past five years, due in part to increased educational campaigns regarding the recognition of symptoms and application of treatment guidelines, the mortality in women still exceeds that of men. The physiological basis for these differences requires further research, with particular attention to two physiological conditions which are unique to women and associated with hormonal changes: pregnancy and menopause. Both conditions have the potential to impact life-long cardiovascular risk, including cerebrovascular function and cognition in women. This review draws on epidemiological, translational, clinical, and basic science studies to assess the impact of hypertensive pregnancy disorders on cardiovascular disease and cognitive function later in life, and examines the effects of post-menopausal hormone treatments on cardiovascular risk and cognition in midlife women. We suggest that hypertensive pregnancy disorders and menopause activate vascular components, i.e., vascular endothelium and blood elements, including platelets and leukocytes, to release cell-membrane derived microvesicles that are potential mediators of changes in cerebral blood flow, and may ultimately affect cognition in women as they age. Research into specific sex differences for these disease processes with attention to an individual’s sex chromosomal complement and hormonal status is important and timely.

Keywords:
Brain imaging; Cerebral blood flow; Cognition; Estrogen; Hormone; Hypertension; Microvesicles; Preeclampsia; White matter hyperintensities