A new study comparing العلاج بالهرمونات البديلة (HRT) has introduced HRT closer to the onset of menopause. The results were published in The New England Journal of Medicine on March 31.
The authors note that studies have shown that HRT is associated with beneficial effects on heart disease when menopause begins temporarily, but not when it starts later. However, the theory that the cardiovascular effects of post-menopausal hormone therapy vary by the time treatment is initiated (hormone-timing theory) has not been tested.
This study included healthy post-menopausal women, divided into two groups based on time from menopause (less than 6 years; early menopause or 10 or more years; late menopause stopped). Subjects were randomly assigned to receive oral 17-estradiol (1 mg per day, plus progesterone 45 mg vaginal gel once daily for 10 days in a 30-day cycle) or placebo. The rate of change in carotid-artery intima-media thickness (CIMT) is the primary outcome measure, measured every 6 months. Secondary outcome measurements include assessment of coronary atherosclerosis by cardiac computed tomography (CT), which is done by women after the completion of a randomly assigned diet.
On the progression of CIMT, the researchers found that after an average five-year period, the effect of estradiol with or without progesterone varies between early and late post-menopausal groups. In women less than 6 years of age from menopause at the beginning of the study, the average CIMT in the placebo group increased by 0.0078 mm per year and in the estradiol group by 0.0078 mm per year. Early in women 10 or more years after menopause, the progression rate of CIMT was similar in the placebo and estradiol groups (HRT: 0.0088; placebo: 0.0100 mmol per year). CT measurements of the coronary – arterial calcium, total stenosis (narrowing of the arteries) and plaque did not differ significantly in any group between the placebo group and the estradiol group.
The authors concluded that oral estradiol treatment was associated with less progression than subclinical atherosclerosis (measured as CIMT) when treatment was started six years after menopause, but not after menopause. Launched 10 or more years later. Estradiol did not have a significant effect on cardiac CT measurements of atherosclerosis in this group.
