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No Reduction in Atherosclerosis Progression with Menopausal Hormone Therapy — Physician’s First Watch

Medical News |
July 29, 2014

No Reduction in Atherosclerosis Progression with Menopausal Hormone Therapy

By Larry Husten

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Menopausal hormone therapy may have favorable effects on some cardiovascular risk factors, but it doesn't reduce the progression of atherosclerosis, according to an Annals of Internal Medicine study.

Over 700 menopausal women were randomized to placebo or one of two low-dose hormone therapies (oral conjugated equine estrogens or transdermal 17β-estradiol, plus progesterone).

After 4 years, there was no difference between the groups in the study's primary endpoint — the progression of atherosclerosis as measured by carotid artery intima-media thickness (CIMT) — or in coronary artery calcium scores. Women in the equine estrogen group had improved lipid profiles, while women in the transdermal group had improved insulin sensitivity. Serious adverse event rates did not differ significantly across the groups.

The investigators offer several explanations for the findings, including a study population at low risk for atherosclerosis, a relatively short study duration, and the use of low-dose rather than high-dose estrogen.

Andrew Kaunitz, editor-in-chief of NEJM Journal Watch Women's Health, says that although it's still unclear what the long term effects of hormone therapy will be on cardiovascular events, the study "does not support using hormone therapy to prevent CVD events."

Reader Comments (3)

Darlene Zimmermann MPH Yale'88 Other, Other, researcher

Using the word progesterone, without quantification, to cover all forms of synthetic progestins and bio-identical progesterone does great harm to women. Chemically they are totally different molecules whose actions in women's bodies are completely different.
MOST IMPORTANTLY, the research quantifying the two types of formulations (synthetic vs bio-identical) in a double -blind placebo research design..HAS NEVER been undertaken..you need to ask WHY has this research never been attempted?

Formulations of HRT that use Estrogen (synthetic) and bio-identical progesterone are almost as heart-protective as Estrogen alone.(PEPI Trial, 1995)
Synthetic progestins negate this heart protective effect of Estrogen. Yet the media continues to publish that HRT is not heart-protective.

Synthetic progesTIN (as opposed to bio-identical progesterone) has been shown not only to be unfriendly to the heart but to be carcinogenic in many well-designed European research studies as well as a few American studies. The time has come for your publication and other media sources to start making this distinction so that women and their Gynecologists can understand risk distinctions.

A simple google search can inform of this distinction.(happy to provide you with a list of research studies to back-up my pronouncements)

Since that landmark PEPI study that showed that estrogen with bio-identical progesterone is heart-protective ,almost to the point of estrogen alone,, we have learned of other deleterious effects of synthetic progestins and for the life of me I cannot understand any physician prescribing it knowing what the researchers know.
The above research does not even inform as the the type of progesterone/progestin used in this study..yet the progestin is the culprit in all of this controversy, not the estrogen. These recommendations are incorrect ,misleading and very harmful to women.

Kathy C Maupin MD Physician, Obstetrics/Gynecology, Own medical practice- BioBalance Health LLC

Amen! I am so tired of reading medical studies that try to baffle practicing doctors and scare the public into believing that not doing anything is always safer than providing medical treatment, especially when it comes to hormone replacement. There are many short term and long term risks to with-holding non-oral hormone replacement. No one mentions the hundreds of excellent studies that prove the cardiovascular benefit of replacing estradiol (non-oral), and testosterone, also non-oral, to menopausal women. Look at all the research cited in this response! Remember that it is a doctor's duty to ease the suffering of patients, even when they are women.

Marilyn Wilking MD Physician

When will there be a study using an oral estrogen that women's bodies make, namely estradiol? And when will the progesterone be intermittent (or not even used in those who have had hysterectomies)? It would seem there should be some attempt to replicate the fertile state or the prepubertal state whether studying cardiovascular risk or osteoporosis or brain health. Using estrogens and progestins that the human body does not make has always seemed to me to be a limiting factor in the validity/applicability of hormone studies.

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