Article

Timing of hormone therapy, type of menopause, and coronary disease in women: Data from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation

Division of Cardiology, Heart Institute and Department of Medicine, Cedars-Sinai Medical Center, 444 S. San Vicente Blvd., Los Angeles, CA 90048, USA.
Menopause (New York, N.Y.) (Impact Factor: 3.36). 04/2011; 18(9):943-50. DOI: 10.1097/gme.0b013e3182113672
Source: PubMed

ABSTRACT

The aim of this study was to assess the relationship of the timing of hormone therapy (HT) use with angiographic coronary artery disease (CAD) and cardiovascular disease (CVD) events in women with natural versus surgical menopause.
We studied 654 postmenopausal women undergoing coronary angiography for the evaluation of suspected ischemia. Timing and type of menopause, HT use, and quantitative angiographic evaluations were obtained at baseline, and the women were followed for a median of 6 years for CVD events.
Ever users of HT had a significantly lower prevalence of obstructive CAD compared with never users (age-adjusted odds ratio, 0.41 [0.28-0.60]). Women with natural menopause initiating HT before age 55 years had lower CAD severity compared with never users (age-adjusted β [SE] = -6.23 [1.50], P < 0.0001), whereas those initiating HT at age 55 years or more did not differ statistically from never users (-3.34 [2.13], P = 0.12). HT use remained a significant predictor of obstructive CAD when adjusted for a "healthy user" model (odds ratio, 0.44 [0.30-0.73]; P = 0.002). An association between HT and fewer CVD events was observed only in the natural menopause group (hazard ratio [95% CI], 0.60 [0.41-0.88]; P = 0.009) but became nonsignificant when adjusted for the presence or severity of obstructive CAD.
Using the quantitative measurements of the timing and type of menopause and HT use, earlier initiation of HT was associated with less angiographic CAD in women with natural but not surgical menopause. Our data suggest that the effect of HT use on reduced cardiovascular event rates is mediated by the presence or absence of angiographic obstructive atherosclerosis.

Download full-text

Full-text

Available from: George Sopko
  • Source
    • "Also in the WHI, women 50 to 59 years old receiving estrogen had less calcified-plaque burden in their coronary arteries compared with placebo (Manson et al., 2007). A more recent case control study also suggested that early initiation of HT reduced the prevalence of abnormal coronary angiograms (Shufelt et al., 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: The American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) are the two largest societies in the world whose members comprise the major experts and professionals working in the field of reproductive medicine and embryology. These societies have never before had a joint scientific meeting. Method(s): A 3-day meeting was planned and took place in March of 2012. The goal was to present and debate key topics, as well as modes of practice in reproductive medicine and to discuss recent developments in the field. Result(s): Presentations by members of ASRM and ESHRE were of three types: 'state of the art' lectures, 'back-to-back' presentations of two points of view and debates. Conclusion(s): For the first time, ASRM and ESHRE held a joint meeting where a special emphasis was given to presentations on the hottest topics in the field. Although different opinions and approaches sometimes exist on the two sides of the Atlantic, an appreciation and acceptance of these differences was evident, and there was more commonality than divergence of opinion.
    Full-text · Article · Oct 2012 · Fertility and sterility
    • "Also in the WHI, women 50 to 59 years old receiving estrogen had less calcified-plaque burden in their coronary arteries compared with placebo (Manson et al., 2007). A more recent case control study also suggested that early initiation of HT reduced the prevalence of abnormal coronary angiograms (Shufelt et al., 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND The American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) are the two largest societies in the world whose members comprise the major experts and professionals working in the field of reproductive medicine and embryology. These societies have never before had a joint scientific meeting. METHODSA 3-day meeting was planned and took place in March of 2012. The goal was to present and debate key topics, as well as modes of practice in reproductive medicine and to discuss recent developments in the field. RESULTSPresentations by members of ASRM and ESHRE were of three types: 'state of the art' lectures, 'back-to-back' presentations of two points of view and debates. CONCLUSIONS For the first time, ASRM and ESHRE held a joint meeting where a special emphasis was given to presentations on the hottest topics in the field. Although different opinions and approaches sometimes exist on the two sides of the Atlantic, an appreciation and acceptance of these differences was evident, and there was more commonality than divergence of opinion.
    No preview · Article · Oct 2012 · Human Reproduction
  • Source
    • "However, reanalysis of these studies has indicated a possible protective window in which recent postmenopausal women in their sixth decade may benefit from HT [1,13]. In addition, it has been speculated that the cardioprotective benefits of HT may be more evident in the early postmenopausal period [14], although this is a controversial issue [15]. In the present study, the use of a sample of apparently healthy and relatively young (mean age of 51.3 ± 3 years) women who were postmenopausal for less than three years (22.2 ± 10 months) enabled us to more accurately demonstrate the neutral or beneficial effects of HT with both non-oral E2 alone or in combination with micronized progesterone- combined period. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Much attention has been drawn to the deleterious effects of adding progestins to estrogen as hormone therapy (HT) in postmenopausal women. Some widely prescribed progestins have been shown to partially oppose the beneficial effects of estrogens on surrogate markers of cardiovascular disease (CVD) risk. Progestins with higher androgenic activity may interfere with lipid profile and glucose tolerance, and could affect mechanisms of estrogen-induced C-reactive protein (CRP) stimulation. Recent data have shown that norpregnane derivatives, but not micronized progesterone, increase the risk of venous thromboembolism among transdermal estrogens users. The aim of the present study was to assess the effects of combining micronized progesterone with non-oral estrogen therapy on lipid profile and cardiovascular risk factors in a sample of early postmenopausal women. Clinical trial including 40 women receiving intranasal 17β estradiol 3 mg/day for two months and 46 women receiving percutaneous 17β estradiol gel 1.5 mg/day for three months (E2). Both groups received an additional 200 mg/day of micronized progesterone by vaginal route 14 days/month (E2+P). Outcome measures included body weight, waist circumference, body mass index (BMI), lipid profile and ultra-sensitive C-reactive protein (usCRP) at baseline and during the E2 or E2+P portions of treatment. Mean age was 51±3 years. Mean time since menopause was 22.2±10 months. Most participants were overweight; HT did not change BMI. E2 and E2+P did not affect waist circumference and weight. Menopausal symptoms improved after HT. The effects of intranasal and percutaneous estradiol were similar, regardless of the addition of progesterone. Similarly, for the overall group of 86 women, micronized progesterone did not alter the response to E2. Blood pressure, glucose, insulin, HDL-c, triglycerides, and usCRP remained constant with or without micronized progesterone. Total cholesterol decreased after E2, and progesterone maintained this reduction. LDL-c levels were similar at baseline and with E2, and lower during E2+P in relation to baseline. Cyclic, short term exposure to vaginal micronized progesterone did not alter the metabolic and cardiovascular effects of non-oral E2 in early, apparently healthy, postmenopausal women. Trial registration ClinicalTrials.gov NCT01432028
    Full-text · Article · Oct 2012 · Lipids in Health and Disease
Show more