Role of estrogen in diastolic dysfunction

Am J Physiol Heart Circ Physiol. 2014 Mar 1;306(5):H628-40. doi: 10.1152/ajpheart.00859.2013. Epub 2014 Jan 10.


The prevalence of left ventricular diastolic dysfunction (LVDD) sharply increases in women after menopause and may lead to heart failure. While evidence suggests that estrogens protect the premenopausal heart from hypertension and ventricular remodeling, the specific mechanisms involved remain elusive. Moreover, whether there is a protective role of estrogens against cardiovascular disease, and specifically LVDD, continues to be controversial. Clinical and basic science have implicated activation of the renin-angiotensin-aldosterone system (RAAS), linked to the loss of ovarian estrogens, in the pathogenesis of postmenopausal diastolic dysfunction. As a consequence of increased tissue ANG II and low estrogen, a maladaptive nitric oxide synthase (NOS) system produces ROS that contribute to female sex-specific hypertensive heart disease. Recent insights from rodent models that mimic the cardiac phenotype of an estrogen-insufficient or -deficient woman (e.g., premature ovarian failure or postmenopausal), including the ovariectomized congenic mRen2.Lewis female rat, provide evidence showing that estrogen modulates the tissue RAAS and NOS system and related intracellular signaling pathways, in part via the membrane G protein-coupled receptor 30 (GPR30; also called G protein-coupled estrogen receptor 1). Complementing the cardiovascular research in this field, the echocardiographic correlates of LVDD as well as inherent limitations to its use in preclinical rodent studies will be briefly presented. Understanding the roles of estrogen and GPR30, their interactions with the local RAAS and NOS system, and the relationship of each of these to LVDD is necessary to identify new therapeutic targets and alternative treatments for diastolic heart failure that achieve the cardiovascular benefits of estrogen replacement without its side effects and contraindications.

Keywords: Doppler echocardiography; G protein-coupled receptor 30; diastolic dysfunction; estrogen; mRen2; sex differences.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Age Factors
  • Animals
  • Diastole* / drug effects
  • Disease Models, Animal
  • Estrogen Replacement Therapy
  • Estrogens / deficiency
  • Estrogens / metabolism*
  • Estrogens / therapeutic use
  • Female
  • Humans
  • Myocardium / metabolism*
  • Nitric Oxide Synthase / metabolism
  • Postmenopause / metabolism
  • Reactive Oxygen Species / metabolism
  • Receptors, Estrogen / metabolism
  • Receptors, G-Protein-Coupled / metabolism
  • Renin-Angiotensin System
  • Risk Factors
  • Sex Factors
  • Signal Transduction
  • Ultrasonography
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / drug therapy
  • Ventricular Dysfunction, Left / etiology
  • Ventricular Dysfunction, Left / metabolism*
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Function, Left* / drug effects


  • Estrogens
  • GPER1 protein, human
  • Reactive Oxygen Species
  • Receptors, Estrogen
  • Receptors, G-Protein-Coupled
  • Nitric Oxide Synthase