Total estrogen time and obstructive coronary disease in women: insights from the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE).
OBJECTIVE
It has been suggested that both endogenous reproductive hormones and hormone therapy may play a protective role against coronary artery disease (CAD). However, recent clinical trials have failed to demonstrate the benefit of a variety of forms of hormone therapy. The observational data on the role of endogenous reproductive hormones, using surrogate measures such as number of birth, age at menarche, and age at menopause are inconsistent. In addition, the longer-term associations have not been evaluated. The aim of this study was to evaluate the relationships between detailed measurements of endogenous and exogenous estrogen exposure time with angiographic CAD and major adverse cardiovascular events.


METHODS
We assessed total estrogen exposure time, quantitative CAD by a core angiography laboratory, and prospectively measured major adverse cardiovascular events in 646 postmenopausal women undergoing coronary angiography for evaluation for suspected ischemia in the Women's Ischemia Syndrome Evaluation (WISE) study.


RESULTS
Timing of postmenopausal exogenous hormone therapy (HT) use was associated with reduced CAD. Two summarized total estrogen time scores (TET and sTET) were not related to angiographic CAD after accounting for HT use. In addition, these scores were not related to cardiovascular events over a median of 6.0 years of follow-up.


CONCLUSIONS
There was no independent relation of estrogen exposure time to angiographic CAD or major adverse cardiovascular events in a contemporary cohort of postmenopausal women evaluated for suspected ischemia. Our results suggest that the paradigm of estrogen protection from CAD in women may be more complex than estrogen exposure duration alone.
Merz
C Noel Bairey
CN
Division of Cardiology, Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. merz@cshs.org
Johnson
B Delia
BD
Berga
Sarah L
SL
Braunstein
Glenn D
GD
Azziz
Ricardo
R
Yang
Yuching
Y
Reis
Steven E
SE
Bittner
Vera
V
Hodgson
T Keta
TK
Pepine
Carl J
CJ
Sharaf
Barry L
BL
Sopko
George
G
Kelsey
Sheryl F
SF
D000368:Aged; D000704:Analysis of Variance; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000000981:diagnostic imaging* / Q000517:prevention & control; D004958:Estradiol / Q000097:blood; D015914:Estrogen Replacement Therapy / Q000379:methods*; D004967:Estrogens / Q000008:administration & dosage / Q000097:blood*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index
D004967:Estrogens; D004958:Estradiol
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