Effects of Conventional or Lower Doses of Hormone Replacement Therapy in Postmenopausal Women

Koh, Kwang Kon; Shin, Mi-Seung; Sakuma, Ichiro; Ahn, Jeong Yeal; Jin, Dong Kyu; Kim, Hyung Sik; Kim, Dae Sung; Han, Seung Hwan; Chung, Wook‐Jin; Shin, Eak Kyun

doi:10.1161/01.atv.0000133683.65877.bc

Cited by 65 publications

(42 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…24,25 Whether an increase in inflammatory mediators such as hs-CRP confers a heightened risk of CVD in these women is uncertain. 26 By contrast, studies of women taking lower doses of estrogen have found little or no effect on hs-CRP levels, 27,28 and women taking selective estrogen receptor modulators as an alternative to conventional oral HRT appear to experience no adverse effects on hs-CRP levels. 29,30 Transvaginal estrogen use also has no impact on hs-CRP levels.…”

Section: Hs-crp and Cardiovascular Risk Prediction Among Womenmentioning

confidence: 98%

C-Reactive Protein as a Risk Predictor

Albert

Ridker

2006

Circulation

View full text Add to dashboard Cite

Section: Hs-crp and Cardiovascular Risk Prediction Among Womenmentioning

confidence: 98%

C-Reactive Protein as a Risk Predictor

Albert

Ridker

2006

Circulation

View full text Add to dashboard Cite

“…Higher doses of estrogen, such as those used in oral contraceptives, may be associated with higher VTE risks when compared with HRT doses [64].…”

Section: Venous Thromboembolism (Vte)mentioning

confidence: 99%

Cardiovascular Risk During the Menopause

Cancelo¹,

Castelo-Branco²

2009

VDP

View full text Add to dashboard Cite

Although initial experimental data and results of observational studies suggest that hormone replacement therapy (HRT) is associated with a reduction in the risk of heart disease, the results for events such as stroke or thromboembolism are less clear. Randomized secondary and primary prevention studies have found that HRT is not protective against the risk of coronary heart disease, stroke or progression of atherosclerosis. Therefore, HRT therapy should not be initiated to prevent vascular disease among postmenopausal women. There are numerous explanations for the divergent findings of observational and randomized clinical trials of HRT. For example, study design and differing biological effects of HRT on vascular risk factors.The use of HRT for young postmenopausal women with moderate to severe menopausal vasomotor symptoms appears to be safe. The absolute risk of vascular event associated with HRT is low and varies depending on factors like age or years since the menopause. The presence or absence of cardiovascular risk factors determines the differences in vascular risk linked to HRT.Further studies should identify the mechanisms involved and determine whether and how different regimens of HRT influence vascular risk as well as the influence of individual patient characteristics.

show abstract

“…18 Low-dose HT (0.3 mg conjugated equine estrogen) had significantly fewer effects on coagulation and inflammatory markers (prothrombin fragment 1ϩ2, antithrombin III, and C-reactive protein) than conventional dose therapy. 19 Thus, dose should remain a consideration when hormonal therapies are prescribed.…”

Section: Dosementioning

confidence: 99%

Are Some Types of Hormone Therapy Safer Than Others?

Manson

2007

Circulation

View full text Add to dashboard Cite

D espite great strides in hormone therapy (HT) research, clinical trial data on the benefit-to-risk profile of different formulations, doses, and routes administration of HT remain lacking. Most of the large-scale clinical trials 1-3 have tested oral conjugated equine estrogens with or without medroxyprogesterone acetate, and data on nonoral routes and different types and doses of estrogens and progestogens have been limited. The evidence is mounting that route of delivery and possibly type and dose of HT are important factors, particularly for venous thromboembolism (VTE). Results of clinical trials 4,5 and observational studies 6 have been concordant in demonstrating an increased risk of VTE with oral exogenous HT. Recent studies suggest that VTE risk may be lower with transdermal than oral estrogen 7 and with estrogen alone than with combined therapy. 4 However, in the absence of rigorous evidence from large-scale clinical trials on differential effects by hormone formulation or route of delivery, should these findings influence clinical practice? Article p 840The Estrogen and Thromboembolism Risk (ESTHER) study, 7 published in the current issue of Circulation, adds important, relevant data to bolster the case that HT type and route of delivery do indeed make a difference. This welldesigned, French, multicenter case-control study of VTE enrolled 271 consecutive cases of VTE in women (age, 45 to 70 years) and matched them to hospital and community controls. Current HT use was present in 46% of the VTE cases compared with 37% of controls. Oral HT users had 4-fold-increased odds of VTE; however, there was no increased risk among transdermal hormone users (odds ratio, 0.9). Previous randomized trials have suggested that the risk of VTE may be higher with combined oral estrogen and progestogen therapy than with estrogen alone. 4,5 In ESTHER, type of progestogen also appeared to influence risk of VTE. Neither micronized progesterone nor pregnane derivatives (including medroxyprogesterone acetate) were associated with VTE, whereas norpregnane derivatives were associated with a 4-fold increase in odds of VTE.The present study has several important strengths, including a large number of carefully adjudicated cases, a population with a large percent of transdermal estrogen users, and a wide variety of progestogen types. Similar data on the relationship of clinical end points to route of estrogen and type of progestogen would not be readily obtainable in the United States, where transdermal preparations and alternate types of progestogens constitute a relatively small proportion of total HT use. Because of small numbers, cases and controls using nortestosterone derivatives were excluded from the main analyses, although a significantly increased risk also was observed in this group.As for any observational or case-control study, selection and confounding biases must be considered. Reasons for choosing a particular progestogen in this population are unknown, so it is possible that clinical factors could have contributed t...

show abstract

Effects of Conventional or Lower Doses of Hormone Replacement Therapy in Postmenopausal Women

Cited by 65 publications

References 60 publications

C-Reactive Protein as a Risk Predictor

C-Reactive Protein as a Risk Predictor

Cardiovascular Risk During the Menopause

Are Some Types of Hormone Therapy Safer Than Others?

Contact Info

Product

Resources

About