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The “healthy endothelium hypothesis” accounts for the duality of estrogen on the natural progression of atherosclerosis by taking in account the early beneficial effects of HRT on healthy endothelium at younger ages and the adverse effects on established plaques typically at older ages. MMP = matrix metalloproteinase; LDL = low-density lipoprotein; CAMs = cell adhesion molecules; SMC = smooth muscle cell; ERα = estrogen receptor alpha; PQ = plaque
