Magazine article Drug Topics
Estrogen May Cut Heart Attack Risk in Postmenopausal Women
The dramatic increase in coronary heart disease in middle-aged women is related to menopause and other factors, such as age and weight gain. It is a compelling reason for postmenopausal patients who can tolerate hormone replacement therapy (HRT) to go on it and for women for whom estrogen therapy is inappropriate to make lifestyle modifications, said Suzanne Oparil, M.D., former president of the American Heart Association. Oparil is director of the Vascular Biology & Hypertension Program at the University of Alabama at Birmingham.
At a recent health and science forum held by the American Heart Association, in Portsmouth, N.H., Oparil explained that while observational studies suggest up to a 50% reduction in heart disease risk in women taking HRT, these studies are severely limited by treatment selection bias. Postmenopausal women on HRT tend to be healthier, better educated, and more attentive to lifestyle-modification strategies for reducing cardiovascular risk. They also have access to better health care. In Oparil's view, several prospective, randomized, doubleblind, placebo-controlled trials are required to assess the impact of postmenopausal HRT on cardiovascular risk factors and rates of heart attack, bypass surgery, and angioplasty.
As an example, Oparil noted the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial, in which researchers are comparing placebo, unopposed estrogen, and each of three estrogen/ progestin regimens on selected heart disease risk factors in healthy postmenopausal women. At three years of follow-up, estrogen alone and combined with progestin increased high-density lipoprotein (HDL) and lowered low-density lipoprotein (LDL) cholesterol and fibrinogen levels.
While estrogen alone was the optimal regimen, it was associated with a high rate of endometrial hyperplasia and of hysterectomy (34% and 6%, respectively). In women with an intact uterus, estrogen combined with progesterone had a favorable effect on HDL with no excess risk of endometrial hyperplasia. …