Effects of transdermal estrogens on endothelial function in postmenopausal women with coronary disease.
OBJECTIVE
Oral estrogens improve endothelial function, and for this reason may be considered cardioprotective; however, in women with coronary heart disease there may also be an increase in the risk of thrombosis. Although transdermal estrogen administration may decrease this adverse effect, there are few data on endothelial function in women with coronary heart disease treated using such therapy. This study aimed to report the endothelial response in postmenopausal women with coronary heart disease treated with transdermal estrogen.


METHODS
This was a double-blind, prospective, randomized study. Eighteen patients with a history of acute coronary syndrome and nine healthy women were studied over 4 weeks. Coronary patients were assigned at random to receive a patch containing either 50 microg estradiol or placebo on a weekly basis. Endothelial function was assessed by flow-mediated vasodilatation of the brachial artery. Baseline blood flow (brachial artery diameter) was measured after 30 min rest and following ischemia, prior to treatment and after 4 weeks.


RESULTS
Flow-mediated vasodilatation in normal patients was 17.8%, whereas in women with coronary disease it was 1.2% (p = 0.0001). Arterial diameter for the resting period in coronary disease subjects increased from 4.22 +/- 0.59 to 4.41 +/- 0.56 mm (p < 0.004) after 4 weeks of estrogen therapy, whereas, in women receiving placebo, it did not change. Flow-mediated vasodilatation in the estrogen group was 3.4% and in the placebo group was 0.5% (p = 0.05).


CONCLUSIONS
Transdermal estrogen may improve endothelial function in women with coronary heart disease.
Climacteric Unit, Barros Luco-Tradeau Hospital, Santiago, Chile.
J E
JE
Blümel
C
C
Castelo-Branco
T
T
Leal
L
L
Gallardo
J
J
Saini
S
S
Ferron
J
J
Haya
D000279:Administration, Cutaneous; D001132:Arm / Q000098:blood supply*; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000187:drug effects / Q000502:physiology*; D003324:Coronary Artery Disease; D004311:Double-Blind Method; D004730:Endothelium, Vascular / Q000187:drug effects / Q000502:physiology; D004958:Estradiol / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D016896:Treatment Outcome; D014664:Vasodilation / Q000187:drug effects / Q000502:physiology
D004958:Estradiol