Hormonal
Initiating hormone replacement therapy (HRT) with conjugated equine estrogens (CEE) after established cardiovascular disease or significant years post-menopause fails to provide cardiovascular protection and may increase early adverse events, whereas initiating therapy with estradiol near the time of menopause in healthy women can slow atherosclerosis progression.
If considering hormone therapy for cardiovascular health, the timing is critical. Starting estrogen therapy shortly after menopause in healthy women may slow atherosclerosis, but starting it years later in women with existing heart disease (especially using conjugated equine estrogens) does not protect the heart and may increase early risk. The type of estrogen matters: estradiol appears more effective than CEE in slowing plaque progression in healthy women.
In contrast, two large randomized clinical trials (RCTs), using conjugated equine estrogens and conducted in older women with established CVD or without overt CVD, failed to demonstrate protection against CVD by exogenous estrogens... The contention that the participants were healthy should be reconsidered... In EPAT, administration of estradiol to postmenopausal women with no evidence of CVD significantly reduced the progression of intimal thickening.
Why this rating
Based on a comprehensive review of large RCTs (HERS, WHI) and observational studies, though the paper itself is a review, not a primary trial.
Source
Vascular consequences of menopause and hormone therapy: Importance of timing of treatment and type of estrogen
Raghvendra K. Dubey et al. · Cardiovascular Research · 2005
DOI 10.1016/j.cardiores.2004.12.012
More from this paper
- Conjugated equine estrogens (CEE) are less effective than endogenous estradiol at inhibiting smooth muscle cell growth and preventing neointima formation due to lower binding affinity and potency at estrogen receptors.Good
- The addition of medroxyprogesterone acetate (MPA) to estrogen therapy may abrogate the cardiovascular protective effects of estrogen, potentially explaining the negative results in combined HRT trials like HERS and WHI.Moderate
Related findings · Hormonal
- Initial treatment for type 2 diabetes should be a combination of metformin and either an SGLT-2 inhibitor or a GLP-1 receptor agonist to achieve cardiorenal protection, rather than monotherapy or older agents like sulfonylureas.Strong
- For patients with specific monogenic obesity syndromes (leptin deficiency, POMC/PCSK1/LEPR mutations), targeted pharmacotherapy (recombinant leptin or setmelanotide) is highly effective and should be prioritized, unlike in polygenic obesity.Strong
- Continued weekly administration of 2.4 mg subcutaneous semaglutide prevents weight regain and promotes further weight loss in adults with overweight or obesity, whereas switching to placebo results in significant weight regain.Strong
This is one finding among thousands. Every one is graded and traced to its source, so you can see what the evidence actually supports. Browse the research →