Hormone therapy and the progression of coronary-artery atherosclerosis in postmenopausal women

Hodis, Howard N.; Mack, Wendy J.; Azen, Stan

doi:10.1016/j.accreview.2003.09.014

Cited by 44 publications

(73 citation statements)

References 31 publications

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“…Many studies suggest that estrogen replacement therapy reduces the number of coronary events after coronary angioplasty in postmenopausal women (O'Brien et al 1996, O'Keefe et al 1997, Khan et al 2000. However, others investigating directly the relationship between MHT with 17b-estradiol alone or in combination with progesterone have shown no benefit on the progression of atherosclerosis (bu-Halawa et al 1998, Herrington et al 2000, Hodis et al 2003. However, these negative studies have been conducted, invariably, in older postmenopausal women with pre-existing stenoses and, as mentioned previously, there is a growing understanding that timing of treatment post menopause onset determines whether hormonal treatment is largely beneficial or not (Manson et al , 2007.…”

Section: Sex Differences In Vessel Repairmentioning

confidence: 94%

Sex differences in vascular function: implication of endothelium-derived hyperpolarizing factor

Villar¹,

Hobbs²,

Ahluwalia

2008

Journal of Endocrinology

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The vascular endothelium plays a crucial role in the regulation of vascular homeostasis by controlling vascular tone, coagulation, and inflammatory responses. These actions are exerted by endothelial factors including nitric oxide, prostacyclin, and endothelium-derived hyperpolarizing factor (EDHF). The greater incidence of cardiovascular disease (CVD) in men and postmenopausal women compared with premenopausal women implies a vasoprotective phenotype of females, which may be influenced by sex hormones. These hormones, particularly estrogen, have modulatory effects on the endothelium and circulating cells that have been implicated in vascular inflammation and in the development of CVD. EDHF seems to be the predominant endothelial factor in the resistance vasculature of females and this mediator could afford the beneficial cardiovascular risk profile observed in premenopausal woman. In this review, we discuss sex differences in EDHF biology and how sex hormones can modulate EDHF responses. We also review the implication of sex hormone-dependent regulation of EDHF in inflammatory processes, platelet function, and repair after vascular damage, each of which have a critical role in several aspects of the pathogenesis of CVD.

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Section: Sex Differences In Vessel Repairmentioning

confidence: 94%

Sex differences in vascular function: implication of endothelium-derived hyperpolarizing factor

Villar¹,

Hobbs²,

Ahluwalia

2008

Journal of Endocrinology

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“…Intermediate outcomes such as coronary angiographic progression for coronary heart disease [25][26][27] and carotid or femoral intima-media thickness for peripheral arterial disease 5-8 demonstrated no benefit from combination hormone therapy. Randomized trials with clinical end points demonstrated no benefit and a suggestion of early harm for both primary and secondary coronary prevention.…”

Section: Discussionmentioning

confidence: 99%

Estrogen Plus Progestin and the Risk of Peripheral Arterial Disease

et al. 2004

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Background-Observational studies have reported less frequent carotid atherosclerosis in healthy women taking postmenopausal hormone therapy. Estrogen with progestin did not reduce peripheral arterial events among women with preexisting coronary heart disease. This analysis evaluates clinical peripheral arterial disease among generally healthy women in the Women's Health Initiative randomized trial of estrogen plus progestin. Methods and Results-The Estrogen Plus Progestin trial assigned 16 608 postmenopausal women, mean age 63.3Ϯ7.1 years, to daily conjugated estrogens (0.625 mg) with medroxyprogesterone acetate (2.5 mg) or placebo and documented health outcomes over an average of 5.6 years of follow-up. Hospitalization for peripheral arterial disease was infrequent, with annualized rates of 0.08%, 0.06%, and 0.02% for carotid disease, lower extremity arterial disease, and abdominal aortic aneurysm, respectively. The incidence of peripheral arterial events did not differ between treatment groups (hazard ratio [HR] 0.89, 95% confidence interval 0.63, 1.25). The risk was slightly greater among women assigned to active estrogen with progestin in years 1 (HR 1.33) and 2 (HR 1.27), and was slightly lower in later years (HR 0.85 and 0.87 in years 5 and Ն6). Among adherent participants, the hazard ratio for peripheral arterial events was 1.23 (95% confidence interval 0.79, 1.91) over the 5.6 years of follow up. Subgroup analysis identified no significant interactions between estrogen with progestin and baseline characteristics with regard to peripheral arterial disease risk. Conclusions-Among

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“…Recent data from two more randomised angiographic studies, the WAVE-trial and the WELL-HART study, confirm the lack of benefit of HRT on the progression of coronary atherosclerotic lesions in women with documented coronary heart disease [23,24].…”

Section: Initiating Hrt In Chd Patientsmentioning

confidence: 99%

“…In these studies, women did not suffer from post-menopausal complaints anymore and started HRT 10-20 years or even more after the onset of menopause. As it is becoming more evident that HRT may maintain vascular health rather than restore endothelial function when atherosclerotic disease is already present, the interval of initiating HRT after cessation of the menstrual periods seems to be crucial in the effectiveness on the vascular system [23]. Until trials have been conducted with cardiovascular endpoints in women early after menopause, it remains uncertain whether HRT in this period of a woman's life can delay clinical signs of atherosclerotic disease.…”

Section: Time Interval Of Starting Hrt After Menopausementioning

confidence: 99%

HRT and heart disease: problems and prospects

et al. 2004

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The divergent findings of hormone replacement therapy (HRT) from observational and randomized clinical studies are summarized and reasons for the different results are postulated. Chronic use of HRT since menopause has no harmful effects on CHD event rate, while the initiation of therapy after a recent cardiovascular event causes an early increase in recurrent CHD events. Once endothelial dysfunction and atherosclerotic disease has developed, the starting of HRT promotes plaque instability, vascular inflammation and prothrombotic effects. The timing of HRT use since menopause is therefore crucial in the effectiveness and safety of HRT on the vascular system.

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Hormone therapy and the progression of coronary-artery atherosclerosis in postmenopausal women

Cited by 44 publications

References 31 publications

Sex differences in vascular function: implication of endothelium-derived hyperpolarizing factor

Sex differences in vascular function: implication of endothelium-derived hyperpolarizing factor

Estrogen Plus Progestin and the Risk of Peripheral Arterial Disease

HRT and heart disease: problems and prospects

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