title: Randomized trial of hormone therapy in women after coronary bypass surgery. Evidence of differential effect of hormone therapy on angiographic progression of disease in saphenous vein grafts and native coronary arteries.
abstract: Clinical trials indicate that hormone therapy (HT) does not decrease cardiovascular disease events or angiographic coronary disease progression. The effects of HT on SVG vessels are unknown. To determine whether postmenopausal hormone therapy started after coronary bypass surgery (CABG) decreases saphenous vein graft (SVG) disease, we conducted a multicenter randomized placebo-controlled angiographic study of estradiol+/-medroxyprogesterone started within 6 months of CABG in 83 postmenopausal women. Angiographic and intravascular ultrasound (IVUS) assessment at 6 and 42 months was planned to assess SVG disease progression. The study was stopped early following publication of the Women's Health Initiative Estrogen/Progestin study. Eighty-three subjects underwent a 6-month angiogram with 63 undergoing IVUS. Forty-five subjects completed the 42-month angiogram (20 underwent 42-month IVUS). In analysis of paired 6- and 42-month angiogram and IVUS studies, HT slowed angiographic progression of SVG disease assessed by mean percent stenosis (p<0.001), minimal lumen diameter (p=0.029), and total plaque volume (p=0.006). In contrast, HT accelerated disease progression in non-bypassed native coronary arteries (minimum lumen diameter, p=0.01). SVG disease and closure occurred in 38% subjects within 1-year post-CABG. The groups had similar frequency of cardiovascular events expect for angioplasty that occurred in eight HT compared to one placebo subject (p<0.05). In HT subjects angioplasty was indicated for native coronary arterial stenoses while in the placebo subject angioplasty was indicated for SVG stenosis. This study suggests that hormone treatment may slow SVG disease progression while accelerating atherosclerosis in non-bypassed native coronary arteries.
authors.affiliation: Johns Hopkins University School of Medicine, John Hopkins Bayview Medical Center, Division of Cardiology, 4940 Eastern Avenue, Baltimore, MD 21224, USA. pouyang@jhmi.edu
authors.forename: Pamela
authors.initials: P
authors.lastname: Ouyang
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.forename: David M
authors.initials: DM
authors.lastname: Herrington
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Stewart
authors.forename: Paul D
authors.initials: PD
authors.lastname: Thompson
authors.forename: Mary N
authors.initials: MN
authors.lastname: Walsh
authors.forename: Susan K
authors.initials: SK
authors.lastname: Bennett
authors.forename: Alan W
authors.initials: AW
authors.lastname: Heldman
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Tayback
authors.forename: Nae-Yuh
authors.initials: NY
authors.lastname: Wang
mesh_terms: D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D018450:Disease Progression; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000517:prevention & control*; D006801:Humans; D008525:Medroxyprogesterone / Q000627:therapeutic use; D008875:Middle Aged; D017698:Postmenopause; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D004958:Estradiol; D008525:Medroxyprogesterone