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Angiographic Study of Estradiol for Secondary Coronary Prevention

In postmenopausal women who took hormones, angiographic findings paralleled earlier clinical findings -- no coronary benefit.

Results of angiographic studies have shown that hormone therapy (HT) with conjugated equine estrogens does not slow progression of coronary atherosclerosis (Journal Watch Sep 1 2000 and Journal Watch Dec 17 2002). However, some critics have wondered whether other estrogen formulations might yield outcomes that are more favorable.

In this double-blind trial, researchers randomly assigned 226 postmenopausal women with angiographically proven coronary disease to 1 of 3 groups: oral micronized estradiol-17ß alone (the endogenous estrogen molecule; 1 mg daily); estradiol-17ß daily plus medroxyprogesterone acetate (5 mg; given for 12 days each month); or placebo. All patients also received lipid-lowering therapy with a target LDL-cholesterol level of <130 mg/dL. Repeat angiography after 3 years of treatment showed no differences between groups in mean percent stenosis or minimal luminal diameter of coronary lesions. In each group, coronary disease progressed in about 60% of patients and regressed in about 5%.

Comment: These angiographic results parallel the findings of secondary prevention studies in which clinical endpoints were examined (e.g., the HERS trial; Journal Watch Aug 28 1998): HT neither slows progression of coronary atherosclerosis nor prevents clinical coronary events among postmenopausal women with coronary disease. These findings suggest that the disappointing performance of HT in secondary prevention applies not only to continuous combination therapy with conjugated equine estrogens but also to estradiol alone and to estradiol plus medroxyprogesterone.

— Allan S. Brett, MD

Published in Journal Watch General Medicine August 15, 2003

Citation(s):

Hodis HN et al. Hormone therapy and the progression of coronary-artery atherosclerosis in postmenopausal women. N Engl J Med 2003 Aug 7; 349:535-45.

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