Lessons from KEEPS: the Kronos Early Estrogen Prevention Study

Area of Science:

• Cardiovascular Health
• Endocrinology
• Women's Health

Background:

• The Kronos Early Estrogen Prevention Study (KEEPS) investigated menopausal hormone treatments (MHTs) in recently menopausal women.
• Cardiovascular disease (CVD) risk increases post-menopause, and MHT's role remains debated.
• Participants were within 3 years of menopause, with no history of overt CVD.

Purpose of the Study:

• To determine if MHTs affect the progression of carotid intima-medial thickness (CIMT).
• To evaluate MHT effects on menopausal symptoms, bone density, and other health aspects.
• To explore the influence of genetic variants on MHT efficacy.

Main Methods:

• A 4-year, randomized, double-blind, placebo-controlled trial.
• Participants received oral conjugated equine estrogens or transdermal 17β-estradiol, both with progesterone, or placebo.
• Carotid intima-medial thickness (CIMT) progression was a primary outcome.

Main Results:

• MHTs did not reduce the age-related increase in CIMT compared to placebo.
• Both MHTs effectively reduced menopausal symptoms and maintained bone density.
• Differences in efficacy were observed for mood, anxiety, sleep, sexual function, and brain amyloid deposition.
• Genetic variants influenced MHT efficacy for certain symptom relief aspects.

Conclusions:

• MHTs do not decrease CIMT progression in recently menopausal women without prior CVD.
• MHTs offer benefits for menopausal symptom relief and bone density maintenance.
• Individualized MHT approaches considering genetic factors may optimize treatment outcomes.