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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2002;22:1692.)
© 2002 American Heart Association, Inc.

Atherosclerosis

Effect of Estrogen Plus Progestin on Progression of Carotid Atherosclerosis in Postmenopausal Women With Heart Disease

HERS B-Mode Substudy

Robert P. Byington; Curt D. Furberg; David M. Herrington; J. Alan Herd; Donald Hunninghake; Maureen Lowery; Ward Riley; Timothy Craven; Lily Chaput; Christine C. Ireland; William B. Applegate for the HERS Research Group^*

From the Wake Forest University School of Medicine (R.P.B., C.D.F., D.M.H., W.R., T.C., W.B.A.), Winston-Salem, NC; Baylor College of Medicine (J.A.H.), Houston, Tex; University of Minnesota (D.H.), Minneapolis; University of Miami School of Medicine (M.L.), Miami, Fla; and University of California (L.C., C.C.I.), San Francisco.

Reprint requests to Robert P. Byington, PhD, Department of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1063. E-mail bbyingto{at}wfubmc.edu

Abstract

Objective— The Heart and Estrogen/Progestin Replacement Study (HERS) found no overall effect of estrogen plus progestin (compared with placebo) on coronary event rates in 2763 postmenopausal women with established coronary disease (mean 4.1 years of follow-up). In addition to the events trial, a carotid ultrasound substudy was established in 1993 to be conducted concurrently to determine whether hormone therapy affects the progression of the underlying atherosclerotic process.

Methods and Results— Within the larger HERS, a subset of 362 participants underwent carotid B-mode ultrasound examinations at baseline and the end of follow-up. Progression of carotid atherosclerosis was measured as the temporal change in intimal-medial thickness (IMT).

Conclusions— IMT progressed in the hormone treatment and placebo groups, although there was no statistical difference between the rates: IMT progressed 26 µm/y (95% CI 18 to 34 µm/y) in the hormone group and 31 µm/y (95% CI 21 to 40 µm/y) in the placebo group (P=0.44). There were also no significant treatment effects when the results were examined by carotid segment or were adjusted for covariates. These data support the American Heart Association recommendation that women with established coronary disease should not initiate hormone therapy with an expectation of atherosclerotic benefit.

Key Words: women • secondary prevention • hormone therapy • carotid artery disease • atherosclerosis

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