Effects of estrogen replacement on the progression of coronary-artery atherosclerosis.

@article{Herrington2000EffectsOE,
  title={Effects of estrogen replacement on the progression of coronary-artery atherosclerosis.},
  author={David M. Herrington and David M. Reboussin and K. Bridget Brosnihan and Penny C. Sharp and Sally A. Shumaker and Thomas E. Snyder and Curt D. Furberg and Glen J. Kowalchuk and Thomas D. Stuckey and William J. Rogers and D H Givens and David D. Waters},
  journal={The New England journal of medicine},
  year={2000},
  volume={343 8},
  pages={
          522-9
        }
}

Effects of Estrogen Replacement in Women with Coronary Disease

The HERS and ERA trials as well as other clinical studies of estrogen and CHD are reviewed, finding no effect of estrogen alone or estrogen plus progestin on progression of coronary artery atherosclerosis.

Hormone Therapy and the Progression of Coronary-Artery Atherosclerosis in Postmenopausal Women

A double-blind, placebo-controlled trial in 226 postmenopausal women with coronary artery disease who had at least one coronary-artery lesion found that the low-density lipoprotein (LDL) cholesterol level was reduced to a target of less than 130 mg per deciliter.

Estrogen in the Prevention of Atherosclerosis

The primary hypothesis was that unopposed ERT significantly reduces the progression of subclinical atherosclerosis in healthy postmenopausal women without preexisting cardiovascular disease.

Clinical cardiovascular studies of hormone replacement therapy.

  • P. Collins
  • Medicine
    The American journal of cardiology
  • 2002

Prevention of cardiovascular disease in women: evidence for the use of hormone replacement therapy

The Women's Hormone Intervention Secondary Prevention (WHISP) pilot study addresses the effect of a novel HRT regimen on lipid and haemostatic risk markers of heart disease and may pave the way for a large trial evaluating the effectof HRT on morbidity and mortality.

Direct Estrogen Effects on the Cardiovascular System

Using data collected from the Nurses Health Study, Grodstein et al. reported that hormone replacement therapy (estrogen or estrogen/progestin) decreased the risk of cardiovascular disease in postmenopausal women by approx 50%.

The role of estrogen in cardiovascular disease.

The Influence of Sex Steroids on Affairs of the Heart

The totality of the evidence now suggests that HRT is effective in CHD prevention, provided that age-appropriate doses are used and treatment is preferably initiated soon after menopause.
...

References

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Postmenopausal estrogen and progestin use and the risk of cardiovascular disease.

The addition of progestin does not appear to attenuate the cardioprotective effects of postmenopausal estrogen therapy, and there was no significant association between stroke and use of combined hormones.

How do we explain the clinical benefits of estrogen? From bedside to bench.

In epidemiological studies, postmenopausal women taking estrogen replacement therapy experience up to 50% fewer adverse coronary events, with the greatest benefit occurring in women with coronary artery disease.

Inhibition of coronary artery atherosclerosis by 17-beta estradiol in ovariectomized monkeys. Lack of an effect of added progesterone.

It is concluded that physiologic estrogen replacement Therapy with or without added progesterone inhibits atherosclerosis progression in ovariectomized monkeys, which may explain why estrogen replacement therapy results in reduced risk of coronary heart disease in postmenopausal women.

Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group.

Treatment with oral conjugated equine estrogen plus medroxyprogesterone acetate did not reduce the overall rate of CHD events in postmenopausal women with established coronary disease and the treatment did increase the rate of thromboembolic events and gallbladder disease.

The HERS Trial Results: Paradigms Lost?

The HERS results have shaken a foundation on which recommendations for widespread use of estrogen replacement have been built and the vast body of evidence from observational, mechanistic, and animal model studies suggesting a cardioprotective effect of estrogenrests in the explanation of this pattern of varying risk over time.

Estrogen monotherapy and combined estrogen-progestogen replacement therapy attenuate aortic accumulation of cholesterol in ovariectomized cholesterol-fed rabbits.

It is shown that estrogen attenuates atherogenesis in cholesterol-fed ovariectomized rabbits and that two commonly prescribed progestogens do not counteract the effect, indicating that estradiol possesses additional beneficial effects, possibly a direct action on the arterial wall.

Effect of postmenopausal hormones on inflammation-sensitive proteins: the Postmenopausal Estrogen/Progestin Interventions (PEPI) Study.

The Postmenopausal Estrogen/Progestin Interventions Trial, a randomized, placebo-controlled trial of the effects of 4 hormone preparations on cardiovascular disease risk factors, found postmenopausal hormones rapidly increased the concentration of the inflammation factor C-reactive protein.

Regression of atherosclerosis in female monkeys.

The major arterial sequelae of lipid lowering in female monkeys were artery and lumen enlargement and improved reactivity of large epicardial coronary arteries and addition of hormone replacement to the dietary modification did not further augment these improvements, except for the dilator capacity of the coronary microcirculation.