Estrogen and coronary heart disease in women

Article Abstract:

It is well known that heart disease affects men and women differently, and that female hormones known as estrogens protected animals on high-fat diets from developing atherosclerosis, or diseased arteries. In spite of this, there have been no large clinical studies of the role of estrogen in the prevention of heart disease in women. Evidence of a protective role of estrogen in the development of heart disease is reviewed. Studies of pregnancy, premature menopause, and prior use of oral contraceptives provide conflicting results. However, the use of unopposed oral estrogen does seem to reduce the risk of coronary heart disease (CHD), although the observational data from which these conclusions are drawn were not the result of rigorously designed research. Three reasons are usually given for not staging a clinical trial of estrogen as a means of preventing CHD in women: the evidence is already in; estrogen is a replacement for a deficiency disease; and a trial is not feasible. In answer to these arguments, it is noted that, first, while estrogen is lacking after menopause, menopause is not a disease. Secondly, oral conjugated equine estrogen without progestin is the only estrogen therapy that has been studied for protecting against heart disease. Oral estrogens are drugs, and a recommendation of estrogen replacement for postmenopausal women warrants a clinical trial, the same as would be required for any other drug. A primary prevention trial would require follow-up of 50,000 women. A workable compromise would be a study of postmenopausal women who already have CHD. Without such a trial, many women will be given a drug without the supporting data required of all other drugs recommended for disease prevention. Until such data are available, estrogen therapy should be reserved for those women already known to be at high risk for developing CHD. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bernardo Study

Article Abstract:

Premenopausal women have far lower mortality from heart disease than men do in Western societies. However, the reverse is true for adult non-insulin-dependent diabetics, and women are now at greater risk than male diabetics for fatal ischemic heart disease (in which blood flow to the heart is impeded by blocked arteries). The Rancho Bernardo (California) study of older, upper-middle-class, white residents measured risk factors for heart disease. The follow-up now extends to 14 years. Of the original population, 207 men and 127 women had diabetes. Hyperglycemia (excessive levels of blood sugar) does not entirely explain the risk of heart disease for men or women. It has been suggested that diabetic women have lower levels of high density lipoprotein (HDL, the so-called ''good cholesterol'') than diabetic men, and are thus at increased risk, but this factor does not explain the difference in mortality. The question arises whether the increased risk is a statistical artifact relating to the low risk of women without diabetes, or a result of the deleterious effects of diabetes in women. The former seems more likely. Evidence also points to an insulin-androgen (a male hormone) interaction. Women with a male pattern of fat (central obesity, or a ''paunch'') have a poor cholesterol profile and increased risk of heart disease. In another study, the waist-to-hip ratio was the strongest predictor of HDL level. Studies point to a relationship between androgens and excess insulin in the blood, as well as higher levels of triglyceride (a fat) and lower HDL cholesterol levels. The Rancho Bernardo study suggests that diabetes increases the probability of developing heart disease for women, and outweighs their usual lower risk. This risk is not affected by the usual heart disease risk factors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Complications and side effects, Risk factors, Type 2 diabetes

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Postmenopausal estrogen use and heart disease risk factors in the 1980s: Rancho Bernardo, Calif, revisited

Article Abstract:

Estrogen replacement therapy in postmenopausal women is still popular despite an increased risk of endometrial cancer in patients. There are several possibilities for the continued popularity of the hormone therapy. Since the warning about endometrial cancer, estrogen therapy has been supplemented with progestin to prevent such risk. In a study of 50- to 79-year-old women enrolled in an ongoing research project, less than one percent of the women were using estrogen-progestin in 1972-1974. By the second phase of the study, in 1984-1987, 26 percent were taking the combination. Estrogen-replacement therapy has also been proven beneficial for the prevention of osteoporosis and postmenopausal bone loss. Finally, the women in the estrogen-replacement study had a more favorable profile of risk factors for heart disease, including lower weight, lower blood pressure and lower cholesterol. Because heart disease is a greater risk to older women than endometrial cancer, these findings should considered when prescribing estrogen therapy.

Analysis, Measurement, Heart diseases, Blood sugar, Blood glucose, Blood pressure, Health risk assessment, Blood cholesterol, Aged women, Elderly women, Blood pressure measurement

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