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Effects of Estrogen Replacement in Women with Coronary Disease

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Women’s Health and Menopause

Part of the book series: Medical Science Symposia Series ((MSSS,volume 17))

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Abstract

Postmenopausal hormone replacement therapy (HRT) has been recommended for the secondary prevention of coronary heart disease (CHD) in women due to observational and experimental studies showing favorable effects on cardiovascular parameters [1 – 5]. But in 1998, the Heart and Estrogen/progestin Replacement Study (HERS) found no overall effect of 4.1 years of estrogen plus progestin on the risk of nonfatal myocardial infarction (MI) and CHD death in a randomized clinical trial of 2,763 women with established coronary disease [6]. Further, there was evidence of an increased risk in Year 1 of HERS that was offset by a trend toward risk reduction in Years 2–5, producing an overall null effect. More recently, the Estrogen Replacement and Atherosclerosis (ERA) trial, a double-blind, randomized, three-arm angiographic trial of 309 women with heart disease, found no effect of estrogen alone or estrogen plus progestin on progression of coronary artery atherosclerosis [7]. Currently, much effort is being devoted to understanding why estrogen seems ineffective for secondary prevention of CHD. This article will briefly review the results from the HERS and ERA trials as well as other clinical studies of estrogen and CHD.

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References

  1. Grady D, Rubin SM, Petitti DB, et al. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med 1992;117:1016–37.

    PubMed  CAS  Google Scholar 

  2. Grodstein F, Stampfer MJ, Goldhaber SZ, et al. Prospective study of exogenous hormones and risk of pulmonary embolism in women. Lancet 1996;348:983–87.

    Article  PubMed  CAS  Google Scholar 

  3. Mendelsohn ME, Karas RH. The protective effects of estrogen on the cardiovascular system. N Eng1 J Med 1999;340:1801–11.

    Article  CAS  Google Scholar 

  4. The Writing Group for the PEPI Trial. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. JAMA 1995;273:199–208.

    Article  Google Scholar 

  5. Adams MR, Kaplan JR, Manuck SB, et al. Inhibition of coronary artery atherosclerosis by 17-beta estradiol in ovariectomized monkeys. Lack of an effect of added progesterone. Arteriosclerosis 1990;10:1051–57.

    Article  PubMed  CAS  Google Scholar 

  6. Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 1998; 280:605–13.

    Article  PubMed  CAS  Google Scholar 

  7. Herrington DM, Reboussin DR, Brosnihan KB, et al. Effects of estrogen replacement on the progression of coronary-artery atherosclerosis. N Engl J Med 2000;343:522–29.

    Article  PubMed  CAS  Google Scholar 

  8. Grodstein F, Manson JE, Stampfer MJ. Postmenopausal hormones and recurrence of coronary events in the Nurses’ Health Study (abstract). Circulation 1999;100:I-871.

    Google Scholar 

  9. Grodstein F, Manson JE, Colditz GA, et al. A prospective, observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease. Ann Intern Med 2000;33:933–41.

    Google Scholar 

  10. Wenger NK, Knatterud GL, Canner PL. Early risks of hormone therapy in patients with coronary heart disease (letter). JAMA 2000;284:41–3.

    Article  PubMed  CAS  Google Scholar 

  11. Heckbert SR, Weiss NS, Psaty BM. Hormone replacement therapy for secondary prevention of coronary heart disease (letter). JAMA 1999;281:795–96.

    PubMed  CAS  Google Scholar 

  12. Daly E, Vessey MP, Hawkins MM, et al. Risk of venous thromboembolism in users of hormone replacement therapy. Lancet 1996;348:977–80.

    Article  PubMed  CAS  Google Scholar 

  13. Jick H, Derby LE, Myers MW, Vasilakis C, Newton KM. Risk of hospital admission for idiopathic venous thromboembolism among users of postmenopausal oestrogens. Lancet 1996;348:981–83.

    Article  PubMed  CAS  Google Scholar 

  14. Grady D, Wenger NK, Herrington D, et al. Postmenopausal hormone therapy increases risk for venous thromboembolic disease. The Heart and Estrogen/progestin Replacement Study. Ann Intern Med 2000;132:689–96.

    PubMed  CAS  Google Scholar 

  15. Vandenbroucke JP, Koster T, Briet E, et al. Increased risk of venous thrombosis in oral contraceptive users who are carriers of the Factor V Leiden mutation. Lancet 1994;344: 1453–57.

    Article  PubMed  CAS  Google Scholar 

  16. Margaglione M, D’Andrea G, Giuliani N, et al. Inherited prothrombotic conditions and premature ischemic stroke. Sex differences in the association with Factor V Leiden. Arterioscler Thromb Vasc Biol 1999;19:1751–56.

    Article  PubMed  CAS  Google Scholar 

  17. Glueck CJ, Wang P, Fontaine RN, et al. Effect of exogenous estrogen on atherothrombotic vascular disease risk related to the presence or absence of the Factor V Leiden mutation. Am J Cardiol 1999;84:549–54.

    Article  PubMed  CAS  Google Scholar 

  18. Poort SR, Rosendaal FR, Reitsma PH, Bertina RM. A common genetic variation in the 3’ untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and increase in venous thrombosis. Blood 1996;88:3698–703.

    PubMed  CAS  Google Scholar 

  19. Hillarp A, Zoller B, Svensson PJ, Dahlback B. The 20210A allele of the prothrombotic gene is a common risk factor among Swedish outpatients with verified deep vein thrombosis. Thromb Haemost 1997;78:990–92.

    PubMed  CAS  Google Scholar 

  20. Leroyer C, Mercier B, Oger E, et al. Prevalence of 20210A allele of the prothrombin gene in venous thromboembolism patients. Thromb Haemost 1998;80:49–51.

    PubMed  CAS  Google Scholar 

  21. Psaty BM, Smith NL, Lemaitre RN, et al. Hormone replacement therapy, prothrombotic mutations, and the risk of incident nonfatal myocardial infarction in postmenopausal women. JAMA 2001;285:906–13.

    Article  PubMed  CAS  Google Scholar 

  22. Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 2000; 342:836–43.

    Article  PubMed  CAS  Google Scholar 

  23. Cushman M, Legault C, Barrett-Connor E, et al. Effect of postmenopausal hormones on inflammation-sensitive proteins. The Postmenopausal Estrogen/Progestin Interventions (PEPI) study. Circulation 1999;100:717–22.

    Article  PubMed  CAS  Google Scholar 

  24. Cushman M, Meilahn EN, Psaty BM, et al. Hormone replacement therapy, inflammation, and hemostasis in elderly women. Arterioscler Thromb Vasc Biol 1999;19:893–99.

    Article  PubMed  CAS  Google Scholar 

  25. Herrington DM, Brosnihan KB. Effects of estrogen vs droloxifene on adhesion molecules and cytokines in healthy postmenopausal women (abstract). J Am Coll Cardiol 1999;33 (Supp1 A):318A.

    Google Scholar 

  26. Herrington DM, Vittinghoff E, Hunninghake D, et al. Effects of statin therapy on cardiovascular events and all-cause mortality in women in the Heart and Estrogen/progestin Replacement Study. Circulation 2000;102(Suppl II):II-837.

    Google Scholar 

  27. Austin MA, Hokanson JE, Edwards KL. Hypertriglyceridemia as a cardiovascular risk factor. Am J Cardiol 1998;81:7B–12B.

    Article  PubMed  CAS  Google Scholar 

  28. Wakatsuki A, Ikenoue N, Sagara Y. Estrogen-induced small low-density lipoprotein particles in postmenopausal women. Obstet Gynecol 1998;91:234–40.

    Article  PubMed  CAS  Google Scholar 

  29. Wakatsuki A, Ikenoue N, Okatani Y, Fukaya T. Estrogen-induced small low density lipoprotein particles may be atherogenic in postmenopausal women. J Am Coll Cardiol 2001;37:425–30.

    Article  PubMed  CAS  Google Scholar 

  30. Raal FJ, Pilcher GJ, Waisberg R, et al. Low-density lipoprotein cholesterol bulk is the pivotal determinant of atherosclerosis in familial hypercholesterolemia. Am J Cardiol 1999;83:1330–33.

    Article  PubMed  CAS  Google Scholar 

  31. Clarke S, Kelleher J, Lloyd-Jones H, et al. Transdermal hormone replacement therapy for secondary prevention of coronary artery disease in postmenopausal women (abstract). Eur Heart J 2000;21:212.

    Google Scholar 

  32. Viscoli CM, Brass LM, Kernan WN, Sarrel PM, Horwitz RI. Effect of estrogen replacement on risk of recurrent stroke and death in the Women’s Estrogen for Stroke Trial (WEST) (abstract). Stroke 2001;32:329.

    Google Scholar 

  33. Angerer P, Stork S, Kothny W, Schmitt P, von Schacky C. Effect of oral postmenopausal hormone replacement on progression of atherosclerosis. A randomized, controlled trial. Arterioscler Thromb Vasc Biol 2001;21:262–68.

    Article  PubMed  CAS  Google Scholar 

  34. Hodis HN, Mack WJ, Lobo RA, et al. Estrogen in the prevention of atherosclerosis trial (abstract). Circulation 2000;102:II–837.

    Article  Google Scholar 

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Authors
  1. David M. Herrington
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  2. Karen Potvin Klein
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Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA

    R. A. Lobo

  2. First Department of Obstetrics and Gynecology, University of Milan, Milan, Italy

    P. G. Crosignani  & F. Bruschi  & 

  3. Department of Pharmacological Sciences, University of Milan, Milan, Italy

    R. Paoletti

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© 2002 Springer Science+Business Media New York

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Herrington, D.M., Klein, K.P. (2002). Effects of Estrogen Replacement in Women with Coronary Disease. In: Lobo, R.A., Crosignani, P.G., Paoletti, R., Bruschi, F. (eds) Women’s Health and Menopause. Medical Science Symposia Series, vol 17. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-1061-1_15

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  • DOI: https://doi.org/10.1007/978-1-4615-1061-1_15

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-5375-1

  • Online ISBN: 978-1-4615-1061-1

  • eBook Packages: Springer Book Archive

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