Estrogens and disease prevention

Article Abstract:

There are now more than 40 million women over the age of 50 in the United States, and the number continues to grow. As the population ages, diseases associated with old age cost more in terms of declining quality of life, as well as increased expenses for health care. Methods of preventing these diseases are needed to maintain quality of life and to control medical costs. The use of estrogen by postmenopausal women to prevent osteoporosis and coronary heart disease, in spite of a possible increased risk of cancer, is one such treatment under study. The study by Brian Henderson and colleagues in the January 1991 Archives of Internal Medicine found reduced mortality from heart disease and stroke, as well as reduced mortality from cancer, among women on estrogen therapy, although the latter finding was not statistically significant. Another study by William Dupont and David Page in the same issue of this journal reported a meta-analysis (a sophisticated and controversial statistical technique) that combined the results of previous studies on estrogen replacement. They concluded that there was no significant increase in breast cancer among women with previous benign breast disease who were taking 0.625 milligrams (mg) estrogen per day or less; their conclusion that the same holds true for doses of 1.25 mg per day was not as convincing. Without a large clinical trial using a control group, estrogen therapy cannot be justified as a national public health policy. The high cost and the time involved make such a trial difficult, but the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial now in progress should help to answer some of the questions about the risks and benefits of postmenopausal hormone therapy. It must be remembered that natural and synthetic drugs affect all the physiological systems, and patients have individual characteristics that determine their need for therapy and their reactions to it. The use of estrogen therapy can serve as a model for the epidemiological evaluation of medical intervention for prevention of disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Prevention, Dosage and administration, Osteoporosis, Preventive medicine, Medicine, Preventive, editorial

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Decreased mortality in users of estrogen replacement therapy

Article Abstract:

Estrogen replacement therapy (ERT) has been used to treat the symptoms of menopause and to reduce the risk of osteoporosis, a bone disease common in older women. However, ERT is controversial because it increases the risk of endometrial (uterine lining) cancer and breast cancer. In 1981, a large-scale, longitudinal survey of elderly residents of a retirement community was undertaken. From this population, data on 8,853 women, over half of whom had used ERT, were obtained. Most of these women had discontinued ERT, but 31 percent were still using it. The results indicated a reduction in overall mortality (death from any cause) of 20 percent for those who had used estrogen at any time, when they were compared with women who had never used ERT. The lower mortality was largely due to fewer deaths from atherosclerosis (fatty deposits in the arteries that may cause heart attacks, strokes, and other complications). These results are in agreement with those of other studies, showing a lower relative risk for heart and circulatory diseases, strokes, and mortality from all causes for those receiving ERT than for non-users. The reason for this presumed benefit may be the favorable action of estrogen on cholesterol levels, which could also be achieved by proper diet. Other possible explanations include hormone changes, dilation of the blood vessels, or a reduced risk of clot formation. Deaths from cancer (including breast cancer) were also lower in the ERT treatment group, which was a surprise. This may have resulted from earlier diagnosis because of improved medical care in this group, or there may be difference between breast cancer associated with estrogen and breast cancer that is not. Because only 60 percent of the women continued using ERT throughout the period of follow-up, it is concluded that mortality could be reduced even further if continuous long-term therapy were more widely used. Women should be fully educated regarding both the risks and benefits of estrogen replacement therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cardiovascular diseases, Risk factors, Breast cancer

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Estrogen replacement and coronary artery disease: effect on survival in postmenopausal women

Article Abstract:

Estrogen replacement in postmenopausal women can be potentially beneficial by altering levels of cholesterol-containing particles in ways that discourage development of cardiovascular disease. Most studies have suggested that estrogen replacement is generally protective in terms of cardiovascular morbidity (disease), while a minority have shown an increase in heart attacks and strokes. Because men given estrogen have heart attacks more frequently, physicians have been reluctant to recommend estrogen therapy for postmenopausal women with heart disease. The effects of estrogen replacement therapy on morbidity and mortality were studied in 1,178 postmenopausal women with severe coronary artery disease, 644 women with mild or moderate coronary artery disease, and 446 women without such disease. Coronary artery disease was confirmed by angiography rather than by reports of chest pain. Postmenopausal women with coronary artery disease who used estrogen had a significantly lower mortality than those who did not. Estrogens were more protective in those with more severe disease. Those without coronary artery disease achieved little benefit from estrogen, probably because there was lower mortality among them than among those with coronary artery disease. Although estrogen does increase the risk of gall bladder disease and cancer of the uterine lining, the risk of death from these causes is less than that from coronary artery disease. The results suggest that postmenopausal women with coronary artery disease can benefit from estrogen replacement therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Coronary heart disease, Postmenopausal women

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