Copyright © 1998 by the European Society of Cardiology.
Does sublingual 17ß-oestradiol have any effects on exercise capacity and myocardial ischaemia in post-menopausal women with stable coronary artery disease?
a Department of Cardiology, Karolinska Hospital and Karolinska Institute, Stockholm, Sweden
d Department of Thoracic Surgery, Karolinska Hospital and Karolinska Institute, Stockholm, Sweden
c Department of Karolinska Pharmacy, Woman and Child Health, Karolinska Hospital and Karolinska Institute, Stockholm, Sweden
b Department of Woman and Child Health, Karolinska Hospital and Karolinska Institute, Stockholm, Sweden
accepted December 20, 1997
Background
A variety of vascular effects have been ascribed to 17ß-oestradiol. These effects may partially explain the reduced incidence of cardiovascular disease found in post-menopausal women on oestrogen replacement therapy.
Objectives
To evaluate the effects of 2mg sublingual 17ß-oestradiol on exercise capacity, exercise-induced myocardial ischaemia and circulating levels of endothelin-1 in post-menopausal women with stable coronary artery disease.
Methods
Twelve post-menopausal women, mean age 61 (range 52–72) years, with angiographically verified significant coronary artery disease, were randomly assigned to 2mg of sublingual 17ß-oestradiol, 2·5mg of buccal nitroglycerine and to placebo in a double-blind cross-over study design with at least 2 days between each of the study arms. Antianginal medications, with the exception of beta-blockers, were discontinued before investigation. All study patients underwent a maximal bicycle exercise test 30min after drug intake. Blood was withdrawn immediately before and up to 8h after medication for analyses of circulating levels of oestradiol and endothelin-1.
Results
The mean serum levels of oestradiol increased from a control level of 72±28pmol.l–1to 3557± 1631pmol.l–1after 30min and to 5028±3971pmol.l–1after 60min with a gradual decline thereafter. Sublingual 17ß-oestradiol did not induce any improvement in exercise duration when compared with nitroglycerin and placebo (500±112s, 505±107s, 498±157s), and did not influence time to onset of ST-segment depression (358±89s, 436±93s, 384±116s). The plasma levels of endothelin-1 did not change after administration of 17ß-oestradiol, nitroglycerin or placebo.
Conclusions
No effects on exercise capacity, exercise-induced acute ischaemia, or plasma levels of endothelin-1 were found after a single dose of 2mg 17ß-oestradiol in post-menopausal women with documented coronary artery disease.
Key Words: 17ß-oestradiol • endothelin-1 • exercise test • coronary artery disease • post-menopausal women
f1 Correspondence: Dr Faris Al-Khalili, Department of Cardiology, The Thoracic Clinics, Karolinska Hospital, Box 110. S-171 76 Stockholm, Sweden.
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