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A recent study raised once again the issue of potential effects of postmenopausal hormone therapy (HT) on the development of coronary artery atherosclerosis [1]. The study group included 654 postmenopausal women undergoing coronary angiography for the evaluation of suspected ischemia. Timing and type of menopause, use of hormone therapy (HT), and quantitative angiographic evaluations were obtained at baseline, and the women were followed for a median period of 6 years for cardiovascular (CVD) events. Ever-users of HT had a significantly lower prevalence of obstructive coronary artery disease (CAD) compared with never-users (age-adjusted odds ratio 0.41; 95% confidence interval (CI) 0.28–0.60). Women with natural menopause initiating HT before age 55 years had lower CAD severity compared with never-users (age-adjusted β [SE] = -6.23 [1.50], [i]p[/i] < 0.0001), whereas those initiating HT at age 55 years or more, actually very few in number, did not differ statistically from never-users. HT use remained a significant predictor of obstructive CAD when adjusted for a ‘healthy user’ model (odds ratio 0.44; 95% CI 0.30-0.73; [i]p[/i] = 0.002). An association between HT and fewer CVD events was observed only in the natural menopause group (hazard ratio 0.60; 95% CI 0.41–0.88; [i]p[/i] = 0.009) but became non-significant when adjusted for the presence or severity of obstructive CAD. Using the quantitative measurements of the timing and type of menopause and HT use, earlier initiation of HT was associated with less angiographic CAD in women with natural but not surgical menopause. The data suggest that the effect of HT use on reduced cardiovascular event rates is mediated by the presence or absence of angiographic obstructive atherosclerosis.

Author(s)

  • Amos Pines
    Department of Medicine T, Ichilov Hospital, Tel-Aviv, Israel

Citations

  1. Shufelt CL, Johnson BD, Berga SL, et al. Timing of hormone therapy, type of menopause, and coronary disease in women: data from the National Heart, Lung, and Blood Institute-sponsored Womens Ischemia Syndrome Evaluation. Menopause 2011;18:943-50.
    http://www.ncbi.nlm.nih.gov/pubmed/21532511
  2. Sullivan JM. Coronary arteriography in estrogen-treated postmenopausal women. Prog Cardiovasc Dis 1995;38:211-22.
    http://www.ncbi.nlm.nih.gov/pubmed/7494883
  3. Herrington DM, Reboussin DM, Brosnihan KB, et al. Effects of estrogen replacement on the progression of coronary-artery atherosclerosis. N Engl J Med 2000;343:5229.
    http://www.ncbi.nlm.nih.gov/pubmed/10954759
  4. Merz CN, Johnson BD, Berga SL, et al. Total estrogen time and obstructive coronary disease in women: insights from the NHLBI-sponsored Womens Ischemia Syndrome Evaluation (WISE). J Womens Health (Larchmt) 2009;18:1315-22.
    http://www.ncbi.nlm.nih.gov/pubmed/19702477
  5. Manson JE, Allison MA, Rossouw JE, et al. Estrogen therapy and coronary-artery calcification. N Engl J Med 2007;356:2591-602.
    http://www.ncbi.nlm.nih.gov/pubmed/17582069
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