title: Hormone therapy and the progression of coronary-artery atherosclerosis in postmenopausal women.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Atherosclerosis Research Unit, Keck School of Medicine, Los Angeles, CA 90033, USA. watcher@usc.edu
authors.forename: Howard N
authors.initials: HN
authors.lastname: Hodis
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Mack
authors.forename: Stanley P
authors.initials: SP
authors.lastname: Azen
authors.forename: Roger A
authors.initials: RA
authors.lastname: Lobo
authors.forename: Donna
authors.initials: D
authors.lastname: Shoupe
authors.forename: Peter R
authors.initials: PR
authors.lastname: Mahrer
authors.forename: David P
authors.initials: DP
authors.lastname: Faxon
authors.forename: Linda
authors.initials: L
authors.lastname: Cashin-Hemphill
authors.forename: Miguel E
authors.initials: ME
authors.lastname: Sanmarco
authors.forename: William J
authors.initials: WJ
authors.lastname: French
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Shook
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Gaarder
authors.forename: Anilkumar O
authors.initials: AO
authors.lastname: Mehra
authors.forename: Ramin
authors.initials: R
authors.lastname: Rabbani
authors.forename: Alex
authors.initials: A
authors.lastname: Sevanian
authors.forename: Asit B
authors.initials: AB
authors.lastname: Shil
authors.forename: Mina
authors.initials: M
authors.lastname: Torres
authors.forename: K Heiner
authors.initials: KH
authors.lastname: Vogelbach
authors.forename: Robert H
authors.initials: RH
authors.lastname: Selzer
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000188:drug therapy*; D018450:Disease Progression; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000009:adverse effects / Q000627:therapeutic use*; D010349:Patient Compliance; D017698:Postmenopause; D017211:Treatment Failure
chemical_list: D004958:Estradiol; D017258:Medroxyprogesterone Acetate