Oestrogens, progestogens and cardiovascular disease



Oestrogens are prescribed to women in two circumstances — as part of oral contraceptive preparations, or as postmenopausal hormone replacement therapy. Oestrogens may also be prescribed to men as part of the treatment of prostatic carcinoma or to lower plasma cholesterol. The relationship of oestrogens and, in the case of oral contraceptives, progestogens to cardiovascular disease has been studied in all these circumstances. This chapter will review the evidence of a relationship between these sex hormones and disease of the coronary or cerebral arteries. Oestrogens are also associated with venous thromboembolism but this will not be discussed here.


Myocardial Infarction Oral Contraceptive Ischaemic Heart Disease Nonfatal Myocardial Infarction Oral Contraceptive User 
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  1. 1.
    Stadel, B. V. (1981). Oral contraceptives and cardiovascular disease. N. Engl. J. Med., 305, 612 and 672PubMedCrossRefGoogle Scholar
  2. 2.
    Vessey, M. P. (1980). Female hormones and vascular disease — an epidemiological overview. Br. J. Fam. Plan., 6, 1Google Scholar
  3. 3.
    Radford, D. J. and Oliver, M. F. (1973). Oral contraceptives and myocardial infarction. Br. Med. J., 3, 428PubMedCrossRefGoogle Scholar
  4. 4.
    Mann, J. I., Vessey, M. P., Thorogood, M. and Doll, R. (1975). Myocardial infarction in young women with special reference to oral contraceptive practice. Br. Med J., 2, 241PubMedCrossRefGoogle Scholar
  5. 5.
    Mann, J. I., Thorogood, M., Waters, W. E. and Powell, C. (1975). Oral contraceptives and myocardial infarction in young women: a further report. Br. Med. J., 3, 631PubMedCrossRefGoogle Scholar
  6. 6.
    Mann, J. I. and Inman, W. H. W. (1975). Oral contraceptives and death from myocardial infarction. Br. Med. J., 2, 245PubMedCrossRefGoogle Scholar
  7. 7.
    Mann, J. I., Inman, W. H. W. and Thorogood, M. (1976). Oral contraceptive use in older women and fatal myocardial infarction. Br. Med. J., 2, 445PubMedCrossRefGoogle Scholar
  8. 8.
    Shapiro, S., Shone, D., Rosenberg, L., Kaufman, D. W., Stolley, P. D. and Miettinen, O. S. (1979). Oral contraceptive use in relation to myocardial infarction. Lancet, 1, 743PubMedCrossRefGoogle Scholar
  9. 9.
    Jick, H., Dinan, B. and Rothman, K. J. (1978). Oral contraceptives and nonfatal myocardial infarction. J. Am. Med. Assoc., 239, 1403CrossRefGoogle Scholar
  10. 10.
    Petitti, D. B., Wingerd, J., Pellegrin, F. and Ramcharan, S. (1979). Risk of vascular disease in women. J. Am. Med. Assoc., 242, 1150CrossRefGoogle Scholar
  11. 11.
    Royal College of General Practitioners’ Oral Contraception Study (1981). Further analyses of mortality in oral contraceptive users. Lancet, 1, 541Google Scholar
  12. 12.
    Krueger, D. E., Ellenberg, S. S., Bloom, S. et al. (1980). Fatal myocardial infarction and the role of oral contraceptives. Am. J. Epidemiol, 111, 655PubMedGoogle Scholar
  13. 13.
    Royal College of General Practitioners (1977). Mortality among oral contraceptive users. Lancet, 2, 727Google Scholar
  14. 14.
    Vessey, M., Doll, R., Peto, R., Johnson, B. and Wiggins, P. (1976). A long term follow- up study of women using different methods of contraception — an interim report. J. Biosoc. Sci., 8, 373PubMedCrossRefGoogle Scholar
  15. 15.
    Vessey, M. P., McPherson, K. and Johnson, B. (1977). Mortality among women participating in the Oxford/Family Planning Association contraceptive study. Lancet, 2, 731PubMedCrossRefGoogle Scholar
  16. 16.
    Vessey, M. P., McPherson, K. and Yeates, D. (1981). Mortality in oral contraceptive users. Lancet, 1, 549PubMedCrossRefGoogle Scholar
  17. 17.
    Slone, D., Shapiro, S., Kaufman, D. W., Rosenberg, L., Miettinen, O. S. and Stolley, P. D. (1981). Risk of myocardial infarction in relation to current and discontinued use of oral contraceptives. N. Engl. J. Med., 305, 420PubMedCrossRefGoogle Scholar
  18. 18.
    Meade, T. W., Greenberg, G. and Thompson, S. G. (1980). Progestogens and cardiovascular reactions associated with oral contraceptives and a comparison of the safety of 50- and 30-μg oestrogen preparations. Br. Med. J., 280, 1157PubMedCrossRefGoogle Scholar
  19. 19.
    Collaborative Group for the study of stroke in young women (1973). Oral contraceptives and increased risk of cerebral ischaemia or thrombosis. N. Engl. J. Med., 288, 871CrossRefGoogle Scholar
  20. 20.
    Irey, N. N. and Norris, H. J. (1973). Intimal vascular lesions associated with female reproductive steroids. Arch. Pathol., 96, 227PubMedGoogle Scholar
  21. 21.
    Irey, N. N., Manion, W. C. and Taylor, H. B. (1970). Vascular lesions in women taking oral contraceptives. Arch. Pathol., 89, 1PubMedGoogle Scholar
  22. 22.
    Gammel, E. B. (1976). Intimal thickening in arteries of rats treated with synthetic sex hormones. Br. J. Exp. Pathol., 57, 248Google Scholar
  23. 23.
    Spain, D. M. (1978). Concerning the pathology of acute coronary heart disease in young women. In Oliver, M. F. (ed.) Coronary Heart Disease in Young Wome., pp. 61–70. (Edinburgh: Churchill Livingstone)Google Scholar
  24. 24.
    Weir, R. J., Briggs, E., Mack, A., Naiswith, L., Taylor, L. and Wilson, E. (1974). Blood pressure in women taking oral contraceptives. Br. Med. J., 1, 533PubMedCrossRefGoogle Scholar
  25. 25.
    Stern, M. P., Brown, B. W., Haskell, W. L., Farquhar, J. W., Wehrle, C. L. and Wood, P. D. S. (1976). Cardiovascular risk and use of estrogens or estrogen-progestagen combinations. J. Am. Med. Assoc., 235, 811CrossRefGoogle Scholar
  26. 26.
    Ostrander, L. D. Jr, Lamphiear, D. E., Block, W. D., Williams, G. W. and Carmen, W. J. (1980). Oral contraceptives and physiological variables. J. Am. Med. Assoc., 244, 677CrossRefGoogle Scholar
  27. 27.
    Bengtsson, C. (1977). Arterial hypertension as a risk factor for ischemic heart disease in women — results from a retrospective and from a prospective study. Acta Med. Scand., suppl. 602, 44Google Scholar
  28. 28.
    Kannel, W. B., Schwartz, M. J. and McNamara, P. M. (1969). Blood pressure and risk of coronary disease. The Framingham study. Dis. Chest, 56, 43PubMedCrossRefGoogle Scholar
  29. 29.
    Kannel, W. B., Wolf, P. A., Verter, J. and McNamara, P. M. (1970). Epidemiologic assessment of the role of blood pressure in stroke. The Framingham study. J. Am. Med. Assoc., 214, 301CrossRefGoogle Scholar
  30. 30.
    Engel, H. J., Hundeshagen, H. and Lichtlen, P. (1977). Transmural myocardial infarction in young women taking oral contraceptives. Evidence of reduced regional coronary flow in spite of normal coronary arteries. Br. Heart J., 39, 477PubMedCrossRefGoogle Scholar
  31. 31.
    Bolton, G. H., Hampton, J. R. and Mitchell, J. R. A. (1968). Effect of oral contraceptive agents on platelets and plasma phospholipids. Lancet, 1, 1336PubMedCrossRefGoogle Scholar
  32. 32.
    Poller, L., Priest, C. M. and Thompson, J. M. (1969). Platelet aggregation during oral contraception. Br. Med. J., 4, 273PubMedCrossRefGoogle Scholar
  33. 33.
    Elkeles, R. S., Hampton, J. R. and Mitchell, J. R. A. (1968). Effects of oestrogen on human platelet behaviour. Lancet, 2, 315PubMedCrossRefGoogle Scholar
  34. 34.
    Poller, L. (1976). Oral contraception and blood clotting. In Gillingham, F. J., Maudsley, C. and Williams, A. E. (eds.) Strok., pp. 315–46. (Edinburgh: Churchill Livingstone)Google Scholar
  35. 35.
    Meade, T. W., Chakrabarti, R., Haines, A. P., Howarth, D. J., North, W. R. S. and Stirling, Y. (1977). Haemostatic, lipid and blood-pressure profiles of women on oral contraceptives containing 50 mg or 30 mg oestrogen. Lancet, 2, 948PubMedCrossRefGoogle Scholar
  36. 36.
    Carvalho, A. C. A., Vaillancourt, R. A., Cabral, R. B., Lees, R. S. and Colman, R. W. (1977). Coagulation abnormalities in women taking oral contraceptives. J. Am. Med. Assoc., 237, 875CrossRefGoogle Scholar
  37. 37.
    Wessler, S. (1980). Thrombosis and sex hormones: a perplexing liaison. J. Lab. Clin. Med., 96, 759Google Scholar
  38. 38.
    Rosenberg, L., Armstrong, B. and Jick, H. (1976). Myocardial infarction and estrogen therapy in postmenopausal women. N. Engl. J. Med., 294, 1256PubMedCrossRefGoogle Scholar
  39. 39.
    Pfeffer, R. I. and Van der Neort, S. (1976). Estrogen use and stroke risk in postmenopausal women. Am. J. Epidemiol., 103, 445PubMedGoogle Scholar
  40. 40.
    Pfeffer, R. I., Whipple, G. H., Kurosaki, T. T. and Chapman, J. M. (1978). Coronary risk and estrogen use in postmenopausal women. Am. J. Epidemiol., 107, 479PubMedGoogle Scholar
  41. 41.
    Rosenberg, L., Slone, D., Shapiro, S., Kaufman, D., Stolley, P. D. and Miettinen, O. S. (1979). Noncontraceptive estrogens and myocardial infarction in young women. J. Am. Med. Assoc., 244, 339CrossRefGoogle Scholar
  42. 42.
    Bain, C., Willett, W., Hennekens, C. H., Rosner, B., Belanger, C. and Speizer, F. E. (1980). Use of postmenopausal hormones and risk of myocardial infarction Circulation, 64, 42CrossRefGoogle Scholar
  43. 43.
    Adam, S., Williams, V. and Vessey, M. P. (1981). Cardiovascular disease and hormone replacement treatment: a pilot case control study. Br. Med. J., 282, 1277CrossRefGoogle Scholar
  44. 44.
    Gordon, T., Kannel, W. B., Hjortland, M. C. and McNamara, P. M. (1978). Menopause and coronary heart disease. The Framingham study. Ann. Intern. Med., 89, 157PubMedGoogle Scholar
  45. 45.
    Jick, H., Dinan, B. and Rothman, K. J. (1978). Noncontraceptive estrogens and nonfatal myocardial infarction. J. Am. Med. Assoc., 239, 1407CrossRefGoogle Scholar
  46. 46.
    Jick, H., Dinan, B. and Rothman, K. J. (1978). Myocardial infarction and other vascular diseases in young women. J. Am. Med. Assoc., 240, 2548CrossRefGoogle Scholar
  47. 47.
    Ross, R. K., Paganni-Hill, A., Mack, T. M., Arthur, M. and Henderson, B. E. (1981). Menopausal oestrogen therapy and protection from death from ischaemic heart disease. Lancet, 1, 858PubMedCrossRefGoogle Scholar
  48. 48.
    Wallace, R. B., Hoover, J., Sandler, D., Rifkind, B. M. and Tyroler, H. A. (1977). Altered plasma-lipids associated with oral contraceptive or oestrogen consumption. Lancet, 2, 11PubMedCrossRefGoogle Scholar
  49. 49.
    Barrett-Connor, E., Brown, V., Turner, J., Austin, M. and Criqui, M. H. (1979). Heart disease risk factors and hormone use in postmenopausal women. J. Am. Med. Assoc., 24, 2167CrossRefGoogle Scholar
  50. 50.
    Hammond, C. B., Jelovsek, F. R., Lee, K. L., Creasman, W. T. and Parker, R. T. (1979). Effects of long-term estrogen replacement therapy. Am. J. Obstet. Gynecol., 133, 525PubMedGoogle Scholar
  51. 51.
    Lindquist, O. and Bengtsson, C. (1980). Serum lipids, arterial blood pressure and body weight in relation to the menopause: results from a population study of women in Goteborg, Sweden. Scand. J. Clin. Invest., 40, 629PubMedCrossRefGoogle Scholar
  52. 52.
    Oliver, M. F. and Boyd, G. S. (1961). Influence of reduction of urn lipids on prognosis of coronary heart-disease. Lancet, 2, 499PubMedCrossRefGoogle Scholar
  53. 53.
    Stamler, J., Pick, R., Katz, L. N. et al. (1965). Effectiveness of estrogen for therapy of myocardial infarction in middle aged men. J. Am. Med. Assoc., 183, 632Google Scholar
  54. 54.
    Marmorstom, J., Moore, F. J., Hopkins, C. E., Kuzma, O. T. and Weiner, J. (1962). Clinical studies of long-term estrogen therapy in men with myocardial infarction. Proc. Soc. Exp. Biol., 110, 400Google Scholar
  55. 55.
    McDowell, F., Louis, S. and McDevitt, E. (1967). A clinical trial of premarin in cerebrovascular disease. J. Chron. Dis., 20, 679CrossRefGoogle Scholar
  56. 56.
    Veterans Administration Co-operative Urological Research Group (1967). Treatment and survival of patients with cancer of the prostate. Surg. Gynecol. Obstet., 124, 1011Google Scholar
  57. 57.
    Coronary Drug Project Research Group (1970). The Coronary Drug Project. Initial findings leading to modifications of its research protocol. J. Am. Med. Assoc., 214, 1303CrossRefGoogle Scholar
  58. 58.
    Coronary Drug Project Research Group (1973). The Coronary Drug Project. Findings leading to discontinuation of the 2.5 mg/day estrogen group. J. Am. Med. Assoc., 226, 652CrossRefGoogle Scholar

Copyright information

© R. W. Stout 1982

Authors and Affiliations

  1. 1.The Queen’s University of BelfastUK

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