ESR1 and atherosclerosis: As sex hormones and chromosomes determine biological sex, it may be that the XX sex chromosome complement accelerates atherosclerosis in women, as was found in the murine Four Core Genotype model.54 Besides the potential role of the sex chromosome complement, estrogen receptor signaling was also previously found in enrichment analyses of female atherosclerotic plaques of women of an average age of 70 years, long after menopause.17 This may imply that estrogen may still be an important factor to consider in postmenopausal women in vascular tissues and suggests long-term epigenetic effects.