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Effects of estrogen replacement on the progression of coronary-artery atherosclerosis
D M Herrington1, D M Reboussin, K B Brosnihan
1Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1045, USA.
Insights
Estrogen therapy, with or without progestin, did not slow the progression of coronary atherosclerosis in women with existing heart disease. These findings indicate that estrogen replacement therapy should not be used for cardiovascular benefits in this population.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Women's Health
Background:
- Heart disease is a leading cause of mortality in women.
- Estrogen's role in cardiovascular health and atherosclerosis requires further investigation, particularly concerning progestin's influence.
- Understanding these effects is crucial for developing effective treatment and prevention strategies.
Purpose of the Study:
- To evaluate the impact of estrogen replacement therapy (ERT) on coronary atherosclerosis progression in women.
- To determine if medroxyprogesterone acetate modifies estrogen's effects on coronary atherosclerosis.
- To assess the cardiovascular benefits of ERT in women with established coronary artery disease.
Main Methods:
- A randomized controlled trial involving 309 women with angiographically confirmed coronary disease.
- Participants received conjugated estrogen, conjugated estrogen plus medroxyprogesterone acetate, or placebo daily.
- Coronary angiograms were analyzed quantitatively at baseline and after a mean follow-up of 3.2 years.
Main Results:
- Estrogen and combination therapy significantly altered lipid profiles, reducing LDL and increasing HDL cholesterol.
- Neither treatment demonstrated a significant effect on the progression of coronary atherosclerosis, as measured by minimal coronary artery diameter.
- Rates of clinical cardiovascular events were comparable across all treatment groups.
Conclusions:
- Estrogen alone or with medroxyprogesterone acetate does not impede the progression of coronary atherosclerosis in women with established disease.
- Women with existing coronary artery disease should not anticipate cardiovascular benefits from estrogen replacement therapy.
- Further research may be needed to explore alternative therapeutic strategies for cardiovascular risk reduction in postmenopausal women.
Background:
Heart disease is a major cause of illness and death in women. To understand better the role of estrogen in the treatment and prevention of heart disease, more information is needed about its effects on coronary atherosclerosis and the extent to which concomitant progestin therapy may modify these effects.
Methods:
We randomly assigned a total of 309 women with angiographically verified coronary disease to receive 0.625 mg of conjugated estrogen per day, 0.625 mg of conjugated estrogen plus 2.5 mg of medroxyprogesterone acetate per day, or placebo. The women were followed for a mean (+/-SD) of 3.2+/-0.6 years. Base-line and follow-up coronary angiograms were analyzed by quantitative coronary angiography.
Results:
Estrogen and estrogen plus medroxyprogesterone acetate produced significant reductions in low-density lipoprotein cholesterol levels (9.4 percent and 16.5 percent, respectively) and significant increases in high-density lipoprotein cholesterol levels (18.8 percent and 14.2 percent, respectively); however, neither treatment altered the progression of coronary atherosclerosis. After adjustment for measurements at base line, the mean (+/-SE) minimal coronary-artery diameters at follow-up were 1.87+/-0.02 mm, 1.84+/-0.02 mm, and 1.87+/-0.02 mm in women assigned to estrogen, estrogen plus medroxyprogesterone acetate, and placebo, respectively. The differences between the values for the two active-treatment groups and the value for the placebo group were not significant. Analyses of several secondary angiographic outcomes and subgroups of women produced similar results. The rates of clinical cardiovascular events were also similar among the treatment groups.
Conclusions:
Neither estrogen alone nor estrogen plus medroxyprogesterone acetate affected the progression of coronary atherosclerosis in women with established disease. These results suggest that such women should not use estrogen replacement with an expectation of cardiovascular benefit.
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