There was approximately a 2 fold higher risk of breast cancer for women in the upper as compared to the lower 25th percentile of bone mineral density. This raises an interesting and important questions about the use of hormone replacement therapy and the potential risk of breast cancer. Again, in the light of the estrogen receptor variance it is now possible that designer estrogens will allow for the selection of drug resistance tumor which would be an entirely different type of disease than what is currently studied. The impact of the estrogen data receptor isoforms on mechanisms of action of testosterone and the potential for steroid therapy in men is completely unknown and a tremendous area of opportunity in improving clinical care for both cardiovascular disease and osteoporosis in both genders. Interestingly,, most of the gains we have made in dealing with coronary artery disease have risen primarily from our improved ability to treat the illness once it is established.
Future efforts require concentrating on risk factor reduction.
One of the most important risk factors being hypertension. While women have a tendency to lower blood pressure than men early in life this is counter balanced by the observation that women's blood pressures increase more steeply as a function of age. The structure of the left ventricle either preceding the development of overt hypertension or in the face of hypertension is remarkably different based upon gender and an area that requires further investigation. It is known to be related to gonadal hormones, but how and the implications for therapeutic modalities is not known. Again, we know little about tissue remodeling and estrogen effects.