A Review of the Epidemiology of Postmenopausal Estrogens and the Risk of Coronary Heart Disease

  • Meir J. Stampfer
Conference paper
Part of the Schering Foundation Workshop book series (SCHERING FOUND, volume 5)

Abstract

Cardiovascular diseases, especially coronary heart disease, remain the leading cause of death in women. The rates are relatively low among premenopausal women, but rise sharply with age. Moreover, the ratio of rates between men and women grows smaller with increasing age (US Department of Health and Human Services 1988). This observation led to speculation that functioning ovaries in premenopausal women were protective. Although the risk of coronary heart disease (CHD) does not abruptly rise at the moment of natural menopause (Colditz et al. 1987; Stampfer et al. 1989), rates of heart disease increase substantially during the period of the climacteric. The increased risk of CHD among young women with bilateral oophorectomy (Stampfer et al. 1989) further supported the view that estrogens play an important role in reducing the risk of CHD in premenopausal women and that estrogen replacement therapy after menopause might decrease the risk.

Keywords

Placebo Cholesterol Obesity Estrogen Osteoporosis 

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References

  1. Adam S, Williams V, Vessey MP (1981) Cardiovascular disease and hormone replacement treatment: a pilot case-control study. Br Med J 282: 12771278Google Scholar
  2. Adams MR, Kaplan JR, Manuck SB, Koritnik DR, Parks JS, Wolfe MS, Clarkson TB (1990) Inhibition of coronary artery atherosclerosis by 17-beta estradiol in ovariectomized monkeys. Lack of an effect of added progesterone. Arteriosclerosis 10: 1051–1057Google Scholar
  3. Bain C, Willett WC, Hennekens CH, Rosner B, Belanger C, Speizer FE (1981) Use of postmenopausal hormones and risk of myocardial infarction. Circulation 64: 42–46PubMedCrossRefGoogle Scholar
  4. Beard CM, Kottke 1’E, Annegers JF, Ballard DJ (1989) The Rochester Coronary Heart Disease Project: impact of cigarette smoking, hypertension, diabetes, and steroidal estrogen use on coronary heart disease among 40–59 year old women, 1960–82. Mayo Clinic Proc (in press)Google Scholar
  5. Burch JC, Byrd Jr BF, Vaughn WK (1974) The effects of long-term estrogen on hysterectomized women. Am J Obstet Gynecol 188: 778–782Google Scholar
  6. Bush TL, Miller VT (1986) Effects of pharmacologic agents used during menopause. Impact on lipids and lipoproteins. In: Mishell D (ed) Menopause: physiology and pharmacology. Year Book Medical Publishers, Chicago, pp 187–208Google Scholar
  7. Bush TL, Cowan LD, Barrett-Connor E, Criqui M, Karon JM, Wallace RB, Tyroler HA, Rifkind BM (1983) Estrogen use and all-cause mortality: preliminary results from the Lipid Research Clinics Program Follow-up Study. JAMA 249: 903–906PubMedCrossRefGoogle Scholar
  8. Bush TL, Barrett-Connor E, Cowan LD, Criqui MH, Wallace RB, Suchindran CM, Tyroler HA, Rifkind BM (1987) Cardiovascular mortality and non-contraceptive use of estrogen in women: results from the Lipid Research Clinics Program Follow-up Study. Circulation 75: 1102–1109PubMedCrossRefGoogle Scholar
  9. Colditz GA, Martin P, Stampfer MJ, Willett WC, Sampson L, Rosner B, Hennekens CH, Speizer FE (1986) Validation of questionnaire on risks factors and disease outcomes in a prospective cohort study in women. Am J Epidemiol 123: 894–900PubMedGoogle Scholar
  10. Colditz GA, Willett WC, Stampfer MJ, Rosner B, Speizer FE, Hennekens CH (1987) Menopause and the risk of coronary heart disease in women. N Engl J Med 316: 1105–1110PubMedCrossRefGoogle Scholar
  11. Criqui MH, Suarez L, Barrett-Connor E, McPhillips J, Wingard DL, Garland C (1988) Postmenopausal estrogen use and mortality. Am J Epidemiol 128: 606–614PubMedGoogle Scholar
  12. Croft P, Hannaford PC (1989) Risk factors for acute myocardial infarction in women: evidence from the Royal College of General Practitioners’ oral contraceptive study. Br Med J 298: 165–168CrossRefGoogle Scholar
  13. Eaker ED, Castelli WP (1987) Coronary heart disease and its risk factors among women in the Framingham Study. In: Eaker E, Packard B, Wenger NK, Clarkson TB, Tyroler HA (eds) Coronary heart disease in women. Haymarket Doyma Inc., New York, pp 122–132Google Scholar
  14. Gordon DJ, Probstfield JL, Garrison RJ, Neaton JD, Castelli WP, Knoke JD, Jacobs Jr DR, Bangdiwala S, Tyroler HA (1989) High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies. Circulation 79: 8–15Google Scholar
  15. Gruchow HW, Anderson AJ, Barboriak JJ, Sobocinski KA (1988) Postmenopausal use of estrogen and occlusion of coronary arteries. Am Heart J 115: 954–963PubMedCrossRefGoogle Scholar
  16. Hammond CB, Jelovsek FR, Lee LK, Creasman WT, Parker RT (1979) Effects of long-term estrogen replacement therapy. I: Metabolic effects. Am J Obstet Gynecol 133: 525–536Google Scholar
  17. Henderson BE, Paganini-Hill A, Ross RK (1988) Estrogen replacement therapy and protection from acute myocardial infarction. Am J Obstet Gynecol 159: 312–317PubMedGoogle Scholar
  18. Hunt K, Vessey M, McPherson K, Coleman M (1987) Long-term surveillance of mortality and cancer incidence in women receiving hormone replacement therapy. Br J Obstet Gynecol 94: 620–635CrossRefGoogle Scholar
  19. Jick H, Dinan B, Herman R, Rothman KJ (1978) Myocardial infarction and other vascular diseases in young women: role of estrogens and other factors. JAMA 240: 2548–2552PubMedCrossRefGoogle Scholar
  20. Jick H, Dinan B, Rothman KJ (1978) Noncontraceptive estrogens and nonfatal myocardial infarction. JAMA 239: 1407–1408PubMedCrossRefGoogle Scholar
  21. Lafferty FW, Helmuth DO (1985) Postmenopausal estrogen replacement: the prevention of osteoporosis and systemic effects. Maturitas 7: 147–159PubMedCrossRefGoogle Scholar
  22. La Vecchia C, Franceschi S, Decarli A, Pampallona S, Tognoni G (1987) Risk factors for myocardial infarction in young women. Am J Epidemiol 125: 832–843PubMedGoogle Scholar
  23. Lobo RA (1990) Estrogen and cardiovascular disease. Ann NY Acad Sci 592: 286–294PubMedCrossRefGoogle Scholar
  24. McFarland KF, Boniface ME, Hornung CA, Earnhardt W, Humphries JO (1989) Risk factors andnoncontraceptive estrogen use in women with and without coronary disease. Am Heart J 117: 1209–1214PubMedCrossRefGoogle Scholar
  25. McMahon B (1978). Cardiovascular disease and noncontraceptive oestrogen therapy. In: Oliver MF (ed) Coronary heart disease in young women. Churchill Livingstone, New York, pp 197–207Google Scholar
  26. Nachtigall LE, Nachtigall RH, Nachtigall RD, Beckman EM (1979) Estrogen replacement therapy II: a prospective study in the relationship to carcinoma and cardiovascular and metabolic problems. Obstet Gynecol 54: 74–79PubMedCrossRefGoogle Scholar
  27. Petitti DB, Perlman JA, Sidney S (1987) Noncontraceptive estrogens and mortality: long-term follow-up of women in the Walnut Creek Study. Obstet Gynecol 70: 289–293PubMedGoogle Scholar
  28. Pfeffer RI, Whipple GH, Kurosaki TT, Chapman JM (1978) Coronary risk and estrogen use in postmenopausal women. Am J Epidemiol 107: 479–487PubMedGoogle Scholar
  29. Potocki J (1971) Wplyw leczenia estrogenami na niewydolnose wiencowa u kobiet po menopauzie. Pol Tyg Lek 26: 1812–1815PubMedGoogle Scholar
  30. Rosenberg L, Armstrong B, Jick H (1976) Myocardial infarction and estrogen therapy in postmenopausal women. N Engl J Med 294: 1256–1259PubMedCrossRefGoogle Scholar
  31. Rosenberg L, Stone D, Shapiro S, Kaufman P, Stolley PD, Miettinen OS (1980) Noncontraceptive estrogens and myocardial infarction in young women. JAMA 244: 339–342PubMedCrossRefGoogle Scholar
  32. Ross RK, Paganini-Hill A, Mack TM, Arthur M, Henderson BE (1981) Menopausal oestrogen therapy and protection from death from ischaemic heart disease. Lancet 1: 858–860PubMedCrossRefGoogle Scholar
  33. Stampfer MJ, Colditz GA (1991) Estrogen replacement therapy and coronary heart disease: a quantitative assessment of the epidemiologic evidence. Prey Med 20: 47–63CrossRefGoogle Scholar
  34. Stampfer MJ, Willett WC, Colditz GA, Rosner B, Speizer FE, Hennekens CH (1985) A prospective study of postmenopausal estrogen therapy and coronary heart disease. N Engl J Med 313: 1044–1049PubMedCrossRefGoogle Scholar
  35. Stampfer MJ, Colditz GA, Willett WC (1989) Menopause and heart disease: a review. Ann NY Acad Sci (in press)Google Scholar
  36. Stampfer MJ, Colditz GA, Willett WC, Manson JE, Rosner B, Speizer FE, Hennekens CH (1991) Postmenopausal estrogen therapy and cardiovascular disease: ten-year follow-up from the Nurses’ Health Study. N Engl J Med 325: 756–762PubMedCrossRefGoogle Scholar
  37. Sullivan JM, Zwagg RV, Lemp GF, Hughes JP, Maddock V, Kroetz FW, Ramanathan KB, Mirvis DM (1988) Postmenopausal estrogen use and coronary atherosclerosis. Ann Int Med 108: 358–363PubMedGoogle Scholar
  38. Szklo M, Tonascia J, Gordis L, Bloom I (1984) Estrogen use and myocardial infarction risk: a case-control study. Prey Med 13: 510–516CrossRefGoogle Scholar
  39. Talbott E, Kuller LH, Detre K, Perper J (1977) Biologic and psychosocial risk factors of sudden death from coronary disease in white women. Am J Cardiol 39: 858–864PubMedCrossRefGoogle Scholar
  40. Thompson SG, Meade TW, Greenberg G (1989) The use of hormonal replacement therapy and the risk of stroke and myocardial infarction in women. J Epidemiol Comm Health 43: 173–178CrossRefGoogle Scholar
  41. US Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Health Statistics (1988) Vital statistics of the United States 1986. Vol II: Mortality, part A. Hyattsville, MarylandGoogle Scholar
  42. Wagner JD, Clarkson TB, St. Clair RW, Schwenke DC, Shively CA, Adams MR (1991) Estrogen and progesterone replacement therapy reduces low density lipoprotein accumulation in the coronary artery of surgically postmenopausal cynomolgus monkeys. J Clin Invest 88: 1995–2002PubMedCrossRefGoogle Scholar
  43. Wilson PW, Garrison RI, Castelli WP (1985) Postmenopausal estrogen use, cigarette smoking, and cardiovascular morbidity in women over 50: the Framingham Study. N Engl J Med 313: 1038–1043PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1992

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  • Meir J. Stampfer

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