Estrogens in human vascular diseases.

Estrogens are correlated with a lower incidence of atherosclerotic vascular disease, but also provide a protective effect on neovascular disorders, such as Kaposi's sarcoma (KS). Estrogens mediate indirect antiatherosclerotic vascular effects by reducing low-density lipoprotein (LDL) levels and by influencing fibrinolysis, and they exert direct actions on vascular cells including vascular relaxation and vasodilatation, thus reducing progression of the lesion. It is increasingly appreciated that the estrogenic effects are mediated not only by the classic genomic action via the specific nuclear hormone receptors ERalpha and ERbeta, but also by distinct rapid, nongenomic actions. Vascular cells have the capacity to express different types of estrogen receptors, and we provide evidence for selective expression of estrogen receptor subtypes on different human vascular cell types. Moreover, we give an overview on the vascular effects of estrogens, selective estrogen receptor modulators (SERMs), and androgens on normal and malignant vascular cells, with particular focus on the protective estrogenic potential on the vasculature.