Vascular benefits of HRT limited to women without atherosclerosis

By Steven Reinberg

NEW YORK (Reuters Health) – Among postmenopausal women receiving hormone replacement therapy (HRT), the favorable vascular effects of estrogen are not seen in those with established cardiovascular disease, researchers report.

"Estrogen may be better in preventing heart disease than it is in treating heart disease," Dr. David M. Herrington, from Wake Forest University School of Medicine, Winston-Salem, North Carolina, told Reuters Health.

Dr. Herrington and colleagues collected data on 1662 women, 65 years of age and older who participated in the 10th annual Cardiovascular Health Study examination. Among these women, 47% had used HRT but only 18% were currently taking HRT. Of the current users, 75.9% were taking unopposed estrogen.

For the 1636 women in whom flow-metered vasodilation was measured, there was no statistical difference found in vasodilation response between women taking and not taking HRT, even after adjusting for confounders. However, in a subset of women who did not have clinical or subclinical cardiovascular disease or risk factors for cardiovascular disease and who were taking HRT, there was a 40% greater vasodilator response, (p = 0.01), Dr. Herrington's team found.

"This suggests that estrogen may be more effective for maintenance of vascular health than it is for treatment of established vascular disease, a hypothesis that remains in need of formal testing," the investigators note in their report in the December 2001 issue of Arteriosclerosis, Thrombosis, and Vascular Biology: Journal of the American Heart Association.

Whether unopposed estrogen is effective for the primary prevention of cardiovascular disease remains an open question that ongoing trials are addressing, Dr. Joseph A. Vita and Dr. John F. Keaney, Jr. of Boston University note in a journal editorial.

"If it turns out that unopposed estrogen has benefit, any clinical recommendations will have to be considered carefully, because of the potential for pro-carcinogenic effects of unopposed estrogen. It remains quite conceivable that these and other adverse effects will outweigh any beneficial effects on the vasculature," Drs. Vita and Keaney conclude.

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