title: Conjugated equine estrogens and peripheral arterial disease risk: the Women's Health Initiative.
abstract: BACKGROUND
  Estradiol reduced progression of ultrasonographic carotid disease in a randomized trial. No trials of unopposed estrogen for prevention of lower extremity arterial disease or aortic aneurysm have been conducted.
  
  
  METHODS
  The Estrogen Alone trial randomized 10739 postmenopausal women with prior hysterectomy, mean age 63.6 +/- 7.3 years, to conjugated equine estrogens (CEE 0.625 mg/d) or placebo and documented health outcomes over an average of 7.1 +/- 1.6 years.
  
  
  RESULTS
  A trend toward increased risk of peripheral arterial events with CEE was observed (hazard ratio [HR] 1.32, 95% CI 0.99-1.77). Carotid arterial events (HR 1.19, 95% CI 0.82-1.74), lower extremity arterial events (HR 1.41, 95% CI 0.86-2.32), and abdominal aortic aneurysm (HR 2.40, 95% CI 0.92-6.23) were more frequent, but not individually significant, in the CEE group. However, the composite of lower extremity arterial disease/abdominal aortic aneurysm was significantly more frequent among women assigned to CEE (HR 1.63, 95 % CI 1.05-2.51). In subgroup analyses, no clear pattern of risk with CEE was apparent by age or by time since menopause.
  
  
  CONCLUSIONS
  Unopposed CEE conferred no protection against peripheral arterial disease among generally healthy postmenopausal women; in fact, there was a suggestion of increased risk.
authors.affiliation: Department of Medicine, George Washington University, Washington, DC, USA. jhsia@mfa.gwu.edu
authors.forename: Judith
authors.initials: J
authors.lastname: Hsia
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.forename: David M
authors.initials: DM
authors.lastname: Herrington
authors.forename: Joann E
authors.initials: JE
authors.lastname: Manson
authors.forename: Lieling
authors.initials: L
authors.lastname: Wu
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.forename: Matthew
authors.initials: M
authors.lastname: Allison
authors.forename: Mary McGrae
authors.initials: MM
authors.lastname: McDermott
authors.forename: Jennifer
authors.initials: J
authors.lastname: Robinson
authors.forename: Kamal
authors.initials: K
authors.lastname: Masaki
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D001157:Arterial Occlusive Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D002340:Carotid Artery Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D004967:Estrogens / Q000009:adverse effects / Q000627:therapeutic use*; D004966:Estrogens, Conjugated (USP) / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008875:Middle Aged; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016387:Women's Health
chemical_list: D004967:Estrogens; D004966:Estrogens, Conjugated (USP)