Effects of Estrogen Therapy on Hormonal Functions and Serum Lipids in Men with Coronary Atherosclerosis

Abstract

Middle-aged men with coronary atherosclerosis were studied before and at intervals after initiation of estrogen therapy over a 12-month period. Serum 365 study was indicated not only of the effects of estrogen on serum lipids but also on various endocrine functions when given over long periods and in large dosage to men. METHOD AND MATERIALA group of 51 men with myocardial infarction have been treated continuously with estrogen for periods of 6 to 48 months (average, 24 months). Of these, 20 middle-aged males (mean age, 50.5 years) were studied before and at intervals up to 1 year after initiation of therapy with 5 to 20 mg. (average, 10 mg.) daily of oral mixed conjugated estrogens (Premarin). This drug was selected for its freedom from production of nausea and vomiting, which permitted long-term administration. Twenty similar patients (mean age, 48.5 years) received placebo tablets and served as a group for comparison. The estrogen-treated and control groups were comparable as to incidence of angina pectoris, myocardial infarction, congestive heart failure, hypertension, and diabetes.The effects of estrogen therapy were explained to both the patient and his wife, and their consent was obtained for the treatment. This precaution minimized any subsequent psychologic difficulties.Serum cholesterol was determined with the acidiron reagent of Zlatkis, Zak, and Boyle,5 after hydrolysis and extraction according to Abell, Levy, Brodie, and Kendall.6 In our hands, this technic yielded cholesterol values averaging 53 ± 1 mg.per cent lower than did the direct method of Zlatkis and co-workers (N = 350; s.d. = 22 mg. per cent). The high intrinsic sensitivity of the acid-iron reaction permitted convenient, routine cholesterol analyses on 0.2 ml. of serum.Lipid phosphorus was estimated by a micromethod involving re-extraction with petroleum ether7 of a dried ethanol-ether (3:1) extract of 0.2 ml. of serum, removal of solvent, wet-ashing ac-

Treatment of Diabetic Retinopathy With Estrogens

“…There are no other clinical or laboratory evidences of increased thyroid function, however. Similarly, although the expected testicular depression accompanies these chemical changes in middle‐aged men with coronary atherosclerosis, no apparent detriment to thyroid or adrenal function has been demonstrated with doses of equine conjugated estrogens averaging 10 mg. daily for periods exceeding one year (100).…”

Effect of Prolonged Use of Estrogens on Circulating Lipids in Patients with Idiopathic Hyperlipemia or Idiopathic Hypercholesteremia

“…', [10][11][12][13][14][15][16] Patients with idiopathic hyperlipemia or idiopathic hypercholesteremia provide a unique material for the study of disturbances in circulating lipids per se and in relation to lipid deposition in the tissues that often accompanies these disorders. 17 …”

Oral and Intravenous Estrogens in the Treatment and Prevention of Bleeding Associated With Long‐term Anticoagulant Therapy

“…, there is a decrease in the serum level of total cholesterol, an elevation in the phospholipids, and a fall in the cholesterol‐phospholipid ratio, even without modification of the dietary fat intake. This is also evident when estrogenic substances are administered orally to men with myocardial infarction (71–74). Diminution in the serum concentration of beta lipoproteins in the S f 12–20 and 20–100 classes following a single intravenous dose of Premarin in a patient with coronary insufficiency has been reported (75).…”