Hormonal
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.
Not all estrogens are equal. CEE, commonly used in HRT, contains weaker estrogens (estrone, estriol) that are less potent at blocking vascular remodeling than pure estradiol. This pharmacological difference may explain why CEE trials failed to show heart benefits while estradiol trials showed some vascular improvement.
In in vitro studies using human aortic SMCs, we demonstrated that in contrast to estradiol, estrone, estriol, estrone sulfate (major components of CEEs) were less potent in inhibiting mitogen-induced SMC growth and mitogen-activated protein kinase activity.
Why this rating
Supported by in vitro studies and non-human primate models cited in the review.
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
- 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.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
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