Short-term oral estrogen replacement therapy does not augment endothelium-independent myocardial perfusion in postmenopausal women.

OBJECTIVES The purpose of this study was to determine the effect of usual-dose estrogen replacement therapy (ERT) on myocardial perfusion and myocardial perfusion reserve (MPR) (evoked by an endothelium-independent vasodilator) in healthy postmenopausal women. Postmenopausal women have a decreased myocardial perfusion reserve compared with younger women. Estrogen infusions are known to enhance endothelium-dependent vasodilation of the epicardial coronary arteries in postmenopausal women, but whether ERT also enhances endothelium-independent myocardial perfusion and perfusion reserve is unclear. METHODS In 24 healthy postmenopausal women who were not taking ERT, myocardial perfusion at rest, perfusion during the infusion of adenosine (a primarily endothelium-independent vasodilator), and MPR were determined by positron-emission tomography (PET) and oxygen 15-labeled water. The women were then randomly assigned in a double-blind fashion to receive either 0.625 mg of oral conjugated estrogens (Premarin) or placebo per day for 4 to 6 weeks, after which they underwent a repeat cardiac PET study. RESULTS There was no statistical difference between those assigned to ERT and those assigned to placebo in the measurement of myocardial perfusion at rest (1.21 +/- 0.31 vs 1.16 +/- 0.18 mL/g/min, respectively) in response to adenosine (2.66 +/- 0.96 vs 3.3 +/- 0.45 mL/g/min) or MPR (2.24 +/- 0.83 vs 2.88 +/- 0.64 mL/g/min) after 4 to 6 weeks of oral ERT. There was also no difference between the groups in any of the myocardial perfusion measurements after correction for the rate-pressure product. CONCLUSIONS Short-term oral ERT does not affect myocardial perfusion at rest in response to adenosine or MPR in healthy postmenopausal women. Thus potential beneficial effects of ERT on vasomotor function may be limited to enhancement of endothelium-dependent vasodilative mechanisms affecting conduit vessels.

[1]  W. Riley,et al.  Individual and combined effects of estrogen/progestin therapy and lovastatin on lipids and flow-mediated vasodilation in postmenopausal women with coronary artery disease. , 1999, Journal of the American College of Cardiology.

[2]  K. Schenck-Gustafsson,et al.  Effect of conjugated estrogen on peripheral flow-mediated vasodilation in postmenopausal women. , 1998, The American journal of cardiology.

[3]  E. Heller.  Clinical nuclear cardiology George Beller, MD , 1997 .

[4]  I. Olivotto,et al.  Effect of aging on myocardial perfusion reserve. , 1995, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[5]  K. Fox,et al.  Acute effect of oestrogen replacement therapy on treadmill performance in postmenopausal women with coronary artery disease. , 1995, European heart journal.

[6]  M. Creager,et al.  Endothelial release of nitric oxide contributes to the vasodilator effect of adenosine in humans. , 1995, Circulation.

[7]  G. Rosano,et al.  Estrogen acutely increases peripheral blood flow in postmenopausal women. , 1995, The American journal of medicine.

[8]  Stamatis Adamopoulos,et al.  17β-Estradiol Attenuates Acetylcholine-Induced Coronary Arterial Constriction in Women but Not Men With Coronary Heart Disease , 1995 .

[9]  R. Cannon,et al.  Effect of combined 17 beta-estradiol and vitamin E on low-density lipoprotein oxidation in postmenopausal women. , 1995, The American journal of cardiology.

[10]  M. Yacoub,et al.  Oestrogen relaxes human epicardial coronary arteries through non‐endothelium-dependent mechanisms , 1995, Coronary artery disease.

[11]  P. Ganz,et al.  Estrogen Improves Endothelium-Dependent, Flow-Mediated Vasodilation in Postmenopausal Women , 1994, Annals of Internal Medicine.

[12]  R. Karas,et al.  Estrogen and the blood vessel wall , 1994, Current opinion in cardiology.

[13]  A. Quyyumi,et al.  Acute Vascular Effects of Estrogen in Postmenopausal Women , 1994, Circulation.

[14]  A. Quyyumi,et al.  Effects of physiological levels of estrogen on coronary vasomotor function in postmenopausal women. , 1994, Circulation.

[15]  D. Herrington,et al.  Endothelial-dependent coronary vasomotor responsiveness in postmenopausal women with and without estrogen replacement therapy. , 1994, The American journal of cardiology.

[16]  P. Herrero,et al.  Effects of time discrepancies between input and myocardial time-activity curves on estimates of regional myocardial perfusion with PET. , 1994, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[17]  D. Rader,et al.  Oestrogen and inhibition of oxidation of low-density lipoproteins in postmenopausal women , 1994, The Lancet.

[18]  G. Burnstock,et al.  A2‐purinoceptor‐mediated relaxation in the guinea‐pig coronary vasculature: a role for nitric oxide , 1993, British journal of pharmacology.

[19]  Caroline S. Fox,et al.  Hormone Therapy To Prevent Disease and Prolong Life in Postmenopausal Women , 1992, Annals of Internal Medicine.

[20]  K. Miura,et al.  Role of endothelium-derived relaxing factor in the in vivo renal vascular action of adenosine in dogs. , 1992, The Journal of pharmacology and experimental therapeutics.

[21]  P. Poole‐Wilson,et al.  Endothelium‐independent relaxation of rabbit coronary artery by 17β‐oestradiol in vitro , 1991, British journal of pharmacology.

[22]  S. Bergmann,et al.  Noninvasive delineation of the effects of moderate aging on myocardial perfusion. , 1991, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[23]  S. Campbell,et al.  Pulsatility index in internal carotid artery in relation to transdermal oestradiol and time since menopause , 1991, The Lancet.

[24]  R. Berne,et al.  Endothelium-dependent and -independent relaxations to adenosine in guinea pig aorta. , 1990, The American journal of physiology.

[25]  P. Herrero,et al.  Quantitation of myocardial blood flow with H2 15O and positron emission tomography: assessment and error analysis of a mathematical approach. , 1989, Journal of computer assisted tomography.

[26]  M. Walsh,et al.  Noninvasive quantitation of myocardial blood flow in human subjects with oxygen-15-labeled water and positron emission tomography. , 1989, Journal of the American College of Cardiology.

[27]  E. Barrett-Connor,et al.  Estrogen use and all-cause mortality. Preliminary results from the Lipid Research Clinics Program Follow-Up Study. , 1983, JAMA.

[28]  W. Kannel,et al.  Menopause and Risk of Cardiovascular Disease: The Framingham Study , 1976 .

[29]  D. Kremastinos,et al.  Estrogen replacement therapy and exercise performance in postmenopausal women with coronary artery disease. , 1997, The American journal of cardiology.

[30]  S. Reis,et al.  Ethinyl estradiol acutely attenuates abnormal coronary vasomotor responses to acetylcholine in postmenopausal women. , 1994, Circulation.

[31]  M. Christiansen,et al.  Serum lipids, lipoproteins, and apolipoproteins during postmenopausal estrogen replacement therapy combined with either 19-nortestosterone derivatives or 17-hydroxyprogesterone derivatives , 1991 .

[32]  G. Colditz,et al.  Estrogen replacement therapy and coronary heart disease: A quantitative assessment of the epidemiologic evidence☆☆☆ , 1991 .