Acute effect of oestrogen replacement therapy on treadmill performance in postmenopausal women with coronary artery disease

Holdright, Diana R.; Sullivan, A K; Wright, Christine; Sparrow, Jane; Cunningham, Deborah; Fox, Keith

doi:10.1093/oxfordjournals.eurheartj.a060779

Cited by 15 publications

(8 citation statements)

References 19 publications

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“…However, the doses of estradiol were supraphysiological, and the results could not be confirmed in a comparable group of postmenopausal women who received 50 µg/24 h of transdermal ethinylestradiol [15]. Neither could any effects on ischemic parameters be found by Al-Khalili et al [17]even though the patients in this investigation received relatively high concentrations of sublingual estradiol.…”

Section: Discussionmentioning

confidence: 59%

“…Data are expressed as means ± SEM. Sample size was estimated from previous studies [14, 15, 17, 18]. All tests were considered significant at p < 0.05.…”

Section: Methodsmentioning

confidence: 99%

“…A positive effect on the frequency of chest pain in patients with syndrome X has also been shown [12, 13]. However, the results of studies on the anti-ischemic effect of estradiol in exercise-induced myocardial ischemia in women with established coronary artery disease have been contradictory [14, 15, 16, 17, 18]. In the investigation by Rosano et al [14]sublingual 17β-estradiol produced significant acute effects on exercise-induced myocardial ischemia in postmenopausal women with verified coronary artery disease.…”

Section: Introductionmentioning

confidence: 99%

“…In the investigation by Rosano et al [14]sublingual 17β-estradiol produced significant acute effects on exercise-induced myocardial ischemia in postmenopausal women with verified coronary artery disease. However, the doses of estradiol were supraphysiological, and the results have not been confirmed in later studies using relatively high doses of sublingual estradiol [17], clinically relevant doses of estrogens [15]or in a long-term (4 weeks) study of the effects of oral conjugated equine estrogen on exercise-induced myocardial ischemia [16]. It should also be noted that in the study by Rosano et al [14], where a significant anti-ischemic effect of estrogen was reported, regular antianginal therapy, including β-blockers, had been withdrawn.…”

Section: Introductionmentioning

confidence: 99%

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Acute Effects of Transdermal Estrogen in Postmenopausal Women with Coronary Artery Disease

Manhem

Ahlm²,

Dellborg³

et al. 2000

Cardiology

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In the present study the acute anti-ischemic effect of clinically relevant doses of transdermal estradiol during concurrent antianginal therapy was investigated in 14 postmenopausal women with stable coronary artery disease. Plasma estradiol was significantly increased, but no significant effects on time to angina, time to 1 mm S–T depression, total exercise time, maximum rate-pressure product, maximum S–T depression or maximum workload were found. However, resting diastolic blood pressure was significantly decreased due to estrogen.

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Section: Discussionmentioning

confidence: 59%

“…Data are expressed as means ± SEM. Sample size was estimated from previous studies [14, 15, 17, 18]. All tests were considered significant at p < 0.05.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Acute Effects of Transdermal Estrogen in Postmenopausal Women with Coronary Artery Disease

Manhem

Ahlm²,

Dellborg³

et al. 2000

Cardiology

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“…Transdermal oestradiol improves forearm blood flow [31] and coronary vasomotion [32], although studies of treadmill performance in CHD patients are contradictory [33,34]. …”

Section: The Coronary Heart Disease Risk Profile Of Transdermal Hormomentioning

confidence: 99%

Do we need clinical trials to test the ability of transdermal HRT to prevent coronary heart disease?

Crook¹

2001

Trials

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CHD = coronary heart disease; CRP = C-reactive protein; HDL = high-density lipoprotein; HRT = hormone replacement therapy; PAI = plasminogen activator inhibitor.Available online http://cvm.controlled-trials.com/content/2/5/211The claim that postmenopausal hormone replacement therapy (HRT) reduces coronary heart disease (CHD) risk by 50% has until recently been a mantra in female health care and, to a lesser extent, in preventive cardiology [1]. This belief originated in the 1960s and is based on the logic that if the menopause causes CHD (a dubious proposal at best) then oestrogen replacement should prevent the disease. Plasma lipoprotein levels were an aspect of metabolism that was at the core of cardiovascular research at that time, and the changes in response to oestrogen were encouraging [2].A low incidence of CHD was subsequently shown in observational (nonrandomized) studies of HRT users [3]. This association was strengthened by the antiatherosclerotic effect of oestrogen demonstrated in fat-fed animals [4], which was consistent with the identification of this steroid as a powerful vasoactive agent.Administration of HRT through skin patches has become a common treatment option in postmenopausal women [5], resonating with the late 20th century distrust of 'pills'. By providing relatively stable blood hormone levels, it was expected to reduce side effects and improve compliance. The major disadvantages, aside from cost, are that patches may fall off or induce skin reactions. These problems have been minimized by advances such as 'matrix' patches that incorporate the steroid in the adhesive layer of the patch. Transdermal HRT is as effective as oral HRT in relieving climacteric symptoms, such as hot flushes, and has comparable effects on bone metabolism and bone density. Some women prefer patches and others prefer pills, and with such a complex and multisystem condition as the menopause it was always unlikely that any one therapy would emerge as a clear favourite.Transdermal and oral HRT differ in their impact on some CHD risk factors (Table 1). The long-standing view that oral HRT prevents CHD has been strongly challenged by recent randomized controlled trials [6]. Whereas a few years ago the question of interest was whether transdermal HRT could match the cardiovascular benefits of oral HRT, we have now entered a new phase in which the transdermal route might even be preferable. AbstractPostmenopausal hormone replacement therapy (HRT) with oral oestrogen was predicted to reduce coronary heart disease (CHD) risk by 50%. Randomized controlled trials show no such benefit, however, pointing instead to an initial increase in CHD events. Although the cardiovascular effects of transdermal HRT are largely unknown, improvements in arterial function are maintained when oestrogen is administered transdermally. Transdermal HRT also avoids the increased plasma levels of C-reactive protein (CRP) that are seen with oral HRT. However, the clinical significance of this general reduction in hepatic over-synthesis of plasma ...

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Management of Stable Angina Pectoris

Frishman

Peterson

Kombert

1999

Developments in Cardiovascular Medicine

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Acute effect of oestrogen replacement therapy on treadmill performance in postmenopausal women with coronary artery disease

Cited by 15 publications

References 19 publications

Acute Effects of Transdermal Estrogen in Postmenopausal Women with Coronary Artery Disease

Acute Effects of Transdermal Estrogen in Postmenopausal Women with Coronary Artery Disease

Do we need clinical trials to test the ability of transdermal HRT to prevent coronary heart disease?

Management of Stable Angina Pectoris

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