B-type natriuretic peptide after hormone therapy in postmenopausal women with chest pain and normal coronary angiogram.
OBJECTIVE
Coronary heart disease is relatively uncommon in premenopausal women but shows a sharp increase after menopause. The decline of endogenous ovarian hormones is commonly assumed to be a major component of this phenomenon. The effects of estrogens on the vasculature have been investigated extensively in previous studies. However, the effects of estrogens on myocardial function have not been evaluated in humans. We sought to examine the effects of hormone therapy (HT) on myocardial function and cardiac natriuretic peptides in postmenopausal women with chest pain and a normal coronary angiogram.


METHODS
Transdermal HT (estradiol: 0.72 mg/2 d) was administered to 15 postmenopausal women with chest pain and a normal coronary angiogram (mean age, 53 y) for 12 weeks, and oral HT (conjugated equine estrogens: 0.625 mg/d) was administered to another 15 postmenopausal women (mean age, 54 y) for 12 weeks. Echocardiography or cardiac catheterization showed no cardiac dysfunction in any woman at baseline. Cardiac function was evaluated by echocardiography, and plasma B-type natriuretic peptide was measured every 4 weeks.


RESULTS
B-type natriuretic peptide levels increased after transdermal HT (baseline: 13.1 +/- 3.1, 4 wk: 22.1 +/- 2.9, 8 wk: 33.2 +/- 3.1, 12 wk: 38.4 +/- 3.3 pg/mL; P < 0.01 vs baseline). The levels were also augmented after oral HT (baseline: 14.1 +/- 3.8, 4 wk: 23.2 +/- 3.3, 8 wk: 35.6 +/- 3.9, 12 wk: 39.6 +/- 3.5 pg/mL; P < 0.01 vs baseline). Serial echocardiography showed no changes in ventricular function in either treatment group. At baseline the serum estradiol levels in the transdermal group were comparable with those in the oral group.


CONCLUSIONS
The estradiol levels after HT increased in both groups, but there was no significant difference between the two groups. B-type natriuretic peptide levels increased without cardiac dysfunction, and the chest symptoms were relieved in some participants after HT. Thus, estrogen supplementation augments natriuretic peptide levels without harmful effects on ventricular function.
Kawano
Hiroaki
H
Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan. koumei@gpo.kumamoto-u.ac.jp
Nagayoshi
Yasuhiro
Y
Soejima
Hirofumi
H
Tanaka
Yasuaki
Y
Hokamaki
Jun
J
Miyamoto
Shinzo
S
Miyazaki
Yuji
Y
Yamabe
Hiroshige
H
Ogawa
Hisao
H
D000279:Administration, Cutaneous; D000284:Administration, Oral; D002637:Chest Pain / Q000097:blood / Q000188:drug therapy*; D017023:Coronary Angiography; D004452:Echocardiography; D004958:Estradiol / Q000008:administration & dosage / Q000494:pharmacology; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000494:pharmacology; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000187:drug effects*; D017698:Postmenopause / Q000187:drug effects*; D016276:Ventricular Function / Q000187:drug effects*
D004967:Estrogens; D020097:Natriuretic Peptide, Brain; D004958:Estradiol; D017258:Medroxyprogesterone Acetate