Hormone Therapy and the Progression of Coronary-Artery Atherosclerosis in Postmenopausal Women
| Autor: | Roger A. Lobo, K. Heiner Vogelbach, Howard N. Hodis, Stanley P. Azen, William J. French, Asit Baran Shil, Thomas D. Gaarder, Anilkumar Mehra, Linda Cashin-Hemphill, Thomas Shook, Mina Torres, Miguel E. Sanmarco, David P. Faxon, Alex Sevanian, Ramin Rabbani, Peter R. Mahrer, Robert H. Selzer, Donna Shoupe, Wendy J. Mack |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
medicine.medical_specialty
Hormone Replacement Therapy medicine.drug_class medicine.medical_treatment Urology Coronary Artery Disease Medroxyprogesterone Acetate Coronary Angiography Coronary artery disease chemistry.chemical_compound Pharmacotherapy Double-Blind Method Internal medicine medicine Humans Medroxyprogesterone acetate Treatment Failure Estradiol business.industry Cholesterol Hormone replacement therapy (menopause) General Medicine medicine.disease Postmenopause Endocrinology chemistry Estrogen Disease Progression Patient Compliance Drug Therapy Combination Female Hormone therapy business hormones hormone substitutes and hormone antagonists Follow-Up Studies Lipoprotein medicine.drug |
| Zdroj: | New England Journal of Medicine. 349:535-545 |
| ISSN: | 1533-4406 0028-4793 |
| DOI: | 10.1056/nejmoa030830 |
| Popis: | In postmenopausal women with coronary artery disease, conjugated equine estrogen with or without continuous administration of medroxyprogesterone acetate has failed to slow the progression of atherosclerosis. Whether 17beta-estradiol (the endogenous estrogen molecule) alone or administered sequentially with medroxyprogesterone acetate can slow the progression of atherosclerosis is unknown.We conducted a double-blind, placebo-controlled trial in 226 postmenopausal women (mean age, 63.5 years) who had at least one coronary-artery lesion. Participants were randomly assigned to usual care (control group), estrogen therapy with micronized 17beta-estradiol alone (estrogen group), or 17beta-estradiol plus sequentially administered medroxyprogesterone acetate (estrogen-progestin group). In all patients the low-density lipoprotein (LDL) cholesterol level was reduced to a target of less than 130 mg per deciliter. The primary outcome was the average per-participant change between base-line and follow-up coronary angiograms in the percent stenosis measured by quantitative coronary angiography.After a median of 3.3 years of follow-up, the mean (+/-SE) change in the percent stenosis in the 169 participants who had a pair of matched angiograms was 1.89+/-0.78 percentage points in the control group, 2.18+/-0.76 in the estrogen group, and 1.24+/-0.80 in the estrogen-progestin group (P=0.66 for the comparison among the three groups). The mean difference in the percent stenosis between the estrogen group and the control group was 0.29 percentage point (95 percent confidence interval, -1.88 to 2.46), and the mean difference between the estrogen-progestin group and the control group was -0.65 (95 percent confidence interval, -2.87 to 1.57).In older postmenopausal women with established coronary-artery atherosclerosis, 17beta-estradiol either alone or with sequentially administered medroxyprogesterone acetate had no significant effect on the progression of atherosclerosis. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|