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Volume 343:522-529 August 24, 2000 Number 8 Next

	Full Text PDF Editorial by Nabel, E. G. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Heart disease is a major cause of illness and death in women. To understand better the role of estrogen in the treatment and prevention of heart disease, more information is needed about its effects on coronary atherosclerosis and the extent to which concomitant progestin therapy may modify these effects.

Methods We randomly assigned a total of 309 women with angiographically verified coronary disease to receive 0.625 mg of conjugated estrogen per day, 0.625 mg of conjugated estrogen plus 2.5 mg of medroxyprogesterone acetate per day, or placebo. The women were followed for a mean (±SD) of 3.2±0.6 years. Base-line and follow-up coronary angiograms were analyzed by quantitative methods.

Results Estrogen and estrogen plus medroxyprogesterone acetate produced significant reductions in low-density lipoprotein cholesterol levels (9.4 percent and 16.5 percent, respectively) and significant increases in high-density lipoprotein cholesterol levels (18.8 percent and 14.2 percent, respectively); however, neither treatment altered the progression of coronary atherosclerosis. After adjustment for measurements at base line, the mean (±SE) minimal coronary-artery diameters at follow-up were 1.87±0.02 mm, 1.84±0.02 mm, and 1.87±0.02 mm in women assigned to estrogen, estrogen plus medroxyprogesterone acetate, and placebo, respectively. The differences between the values for the two active-treatment groups and the value for the placebo group were not significant. Analyses of several secondary angiographic outcomes and subgroups of women produced similar results. The rates of clinical cardiovascular events were also similar among the treatment groups.

Conclusions Neither estrogen alone nor estrogen plus medroxyprogesterone acetate affected the progression of coronary atherosclerosis in women with established disease. These results suggest that such women should not use estrogen replacement with an expectation of cardiovascular benefit.

Source Information

From the Section on Cardiology, Department of Internal Medicine (D.M.H.), the Department of Public Health Sciences (D.M.R., S.A.S., C.D.F.), the Hypertension and Vascular Disease Center (K.B.B.), the Department of Family and Community Medicine (P.C.S.), and the Department of Obstetrics and Gynecology (T.E.S.), Wake Forest University School of Medicine, Winston-Salem, N.C.; the Department of Cardiology, Carolinas Medical Center, Charlotte, N.C. (G.J.K.); LeBauer Cardiovascular Associates, Greensboro, N.C. (T.D.S.); the Division of Cardiology, University of Alabama at Birmingham, Birmingham (W.J.R.); Winston-Salem Cardiology Associates, Winston-Salem, N.C. (D.H.G.); and the Division of Cardiology, San Francisco General Hospital, San Francisco (D.W.).

Address reprint requests to Dr. Herrington at the Department of Internal Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1045.

Full Text of this Article

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Extract | Full Text  
N Engl J Med 2000; 343:1891-1894, Dec 21, 2000. Correspondence

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