Estrogen replacement and coronary artery disease: effect on survival in postmenopausal women

Estrogen replacement in postmenopausal women can be potentially beneficial by altering levels of cholesterol-containing particles in ways that discourage development of cardiovascular disease. Most studies have suggested that estrogen replacement is generally protective in terms of cardiovascular morbidity (disease), while a minority have shown an increase in heart attacks and strokes. Because men given estrogen have heart attacks more frequently, physicians have been reluctant to recommend estrogen therapy for postmenopausal women with heart disease. The effects of estrogen replacement therapy on morbidity and mortality were studied in 1,178 postmenopausal women with severe coronary artery disease, 644 women with mild or moderate coronary artery disease, and 446 women without such disease. Coronary artery disease was confirmed by angiography rather than by reports of chest pain. Postmenopausal women with coronary artery disease who used estrogen had a significantly lower mortality than those who did not. Estrogens were more protective in those with more severe disease. Those without coronary artery disease achieved little benefit from estrogen, probably because there was lower mortality among them than among those with coronary artery disease. Although estrogen does increase the risk of gall bladder disease and cancer of the uterine lining, the risk of death from these causes is less than that from coronary artery disease. The results suggest that postmenopausal women with coronary artery disease can benefit from estrogen replacement therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)