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

Original Internist,  Sept, 2003  

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Background: In postmenopausal women with coronary artery disease, conjugated equine estrogen with or without continuous administration of medroxyprogesterone acetate has failed to slow the progression of atherosclerosis. Whether 17 B-estradiol (the endogenous estrogen molecule) alone or administered sequentially with medroxyprogesterone acetate can slow the progression of atherosclerosis in unknown.

Methods: We conducted a double-blind, placebocontrolled trial in 226 postmenopausal women (mean age, 63.5 years) who had at least one coronary-artery lesion. Participants were randomly assigned to usual care (control group), estrogen therapy with micronized 17 B-estradiol alone (estrogen group), or 17 B-estradiol plus sequentially administered medroxyprogesterone acetate (estrogen-progestin group). In all patients the low-density lipoprotein (LDL) cholesterol level was reduced to a target of less than 130 mg per deciliter. The primary outcome was the average per-participant change between baseline and follow-up coronary angiograms in the percent stenosis measured by quantitative coronary angiography.

Result: After a median of 3.3 years of follow-up, the mean ([+ or -]SD) change in the percent stenosis in the 169 participants who had a pair of matched angiograms was 1.89[+ or -]0.78 percentage points in the control group, 2.18[+ or -]0.76 in the estrogen group, and 1.24 [+ or -]0.80 in the estrogen-progestin group (P=0.66 for the comparison among the three groups). The mean difference in the percent stenosis between the estrogen group and the control group was 0.29 percentage point (95% confidence interval, -1.88 to 2.46), and the mean difference between the estrogen-progestin group and the control group was -0.65 (95% confidence interval, -2.87 to 1.57).

Conclusions: In older postmenopausal women with established coronary-artery atherosclerosis. 17 B-estradiol either alone or with sequentially administered medroxyprogesterone actetate had no significant effect on the progression of atherosclerosis.

Hodis HN. et al. N Engl J Med, August 7, 2003:349 (6):535-545.

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