Arteriosclerosis, Thrombosis, and Vascular Biology. 2001;21:262-268
© 2001 American Heart Association, Inc.
Atherosclerosis and Lipoproteins |
Effect of Oral Postmenopausal Hormone Replacement on Progression of Atherosclerosis
A Randomized, Controlled Trial
From the Medizinische Klinik, Klinikum der Universität München–Innenstadt, München, Germany.
Abstract—Postmenopausal
hormone replacement therapy (HRT) is associated with low
cardiovascular morbidity and mortality in
epidemiological studies. Yet, no randomized trial has examined whether
HRT is effective for prevention of coronary heart disease (CHD)
in women with increased risk. The objective of this study was to
determine whether HRT can slow progression of
atherosclerosis, measured as intima-media thickness
(IMT) in carotid arteries. Carotid IMT is an appropriate intermediate
end point to investigate clinically relevant effects on atherogenesis.
This randomized, controlled, observer-blind, clinical, single-center
trial enrolled 321 healthy postmenopausal women with increased IMT in
1 segment of the carotid arteries. For a period of 48 weeks, subjects
received either 1 mg/d 17ß-estradiol continuously plus 0.025 mg
gestodene for 12 days every month (standard-progestin group), or 1 mg
17ß-estradiol plus 0.025 mg gestodene for 12 days every third month
(low-progestin group), or no HRT. Maximum IMT in 6 carotid artery
segments (common, bifurcation, and internal, both sides) was measured
by B-mode ultrasound before and after intervention. HRT did not slow
IMT progression in carotid arteries. Mean maximum IMT in the carotid
arteries increased by 0.02±0.05 mm in the no HRT group and by
0.03±0.05 and 0.03±0.05 mm, respectively, in the HRT
groups (P>0.2). HRT
significantly decreased LDL cholesterol, fibrinogen, and
follicle-stimulating hormone. In conclusion, 1 year of HRT was not
effective in slowing progression of subclinical
atherosclerosis in postmenopausal women at increased
risk.
Key Words: atherosclerosis • carotid arteries • hormones • prevention • women
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