What’s the impact of hormone therapy on heart health?

According to a recent study in Annals of Internal Medicine, hormonal therapy in early menopause may improve some markers of cardiovascular disease (CVD) risk, but not progression of atherosclerosis.

Led by researchers from Phoenix Veterans Affairs Care System, the study included 727 healthy menopausal women aged 42 to 58 years between 6 and 36 months from last menses without prior CVD events. They had coronary artery calcium scores <50 Agatston units and had received no estrogen or lipid-lowering agent for at least 90 days. Randomization was to either oral conjugated equine estrogens (o-CEE), 0.45 mg/d, or transdermal 17β-estradiol (t-E₂), 50 mcg/d, each with 200 mg of oral progesterone for 12 days per month, or placebo for 48 months.

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The annual change in carotid artery intima-media thickness (CIMT) measurement was the primary end point; secondary end points included changes in markers of CVD risk.

Of the participants, 89.3% had at least 1 follow-up CIMT during the study period and 79.8% had CIMT at 48 months. For all groups, the mean CIMT increase was 0.007 mm/y. Across groups, the percentage of participants whose coronary artery calcium score increased also was similar. No effects on blood pressure were seen for either o-CEE or t-E₂. With o-CEE, improvements were seen in levels of C-reactive protein, sex hormone-binding globulin, and low- and high-density lipoprotein levels but not in interleukin-6. Decreased insulin resistance was associated with t-E₂. No difference in serious adverse events was seen between treatments.

Investigators concluded that despite improving some CVD risk factors, 4 years of early hormonal therapy did not have an effect on atherosclerosis. 

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