European Heart Journal Advance Access originally published online on February 26, 2009
European Heart Journal 2009 30(8):978-986; doi:10.1093/eurheartj/ehp013
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Effect of hormone replacement therapy on vasomotor function of the coronary microcirculation in post-menopausal women with medically treated cardiovascular risk factors
1 Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 10833 Le Conte Ave, 23-120 CHS, Box 173517, Los Angeles, CA 90095-1735, USA
2 Département de Médicine Interne, Service Cardiologie, Hôpitaux Universitaires de Genève (HUG), Genève, Switzerland
3 Institute for Medical Statistics and Biometry, Albert Ludwig University, Freiburg, Germany
Received 24 August 2008; revised 18 December 2008; accepted 5 January 2009; online publish-ahead-of-print 26 February 2009.
* Corresponding author. Tel: +1 310 825 3076, Fax: +1 310 267 2677, Email: hschelbert{at}mednet.ucla.edu
Aims: The aim of this study was to evaluate the effect of hormone replacement therapy (HRT) on coronary vasomotor function in post-menopausal women (PM) with medically treated cardiovascular risk factors (RFs) in a cross-sectional and a longitudinal follow-up (FU) study.
Methods and results: Myocardial blood flow (MBF) response to cold pressor testing (CPT) and during pharmacologically induced hyperaemia was measured with positron emission tomography in pre-menopausal women (CON), in PM with HRT and without HRT, and repeated in PM after a mean FU of 24 ± 14 months. When compared with CON at baseline, the endothelium-related change in MBF (
MBF) to CPT progressively declined in PM with HRT and without HRT (0.35 ± 0.23 vs. 0.24 ± 0.20 and 0.16 ± 0.12 mL/g/min; P = 0.171 and P = 0.021). In PM without HRT and in those with HRT at baseline but with discontinuation of HRT during FU, the endothelium-related MBF to CPT was significantly less at FU than at baseline (0.05 ± 0.19 vs. 0.16 ± 0.12 and –0.03 ± 0.14 vs. 0.25 ± 0.18 mL/g/min; P = 0.023 and P = 0.001), whereas no significant change was observed in PM with HRT (0.19 ± 0.22 vs. 0.23 ± 0.22 mL/g/min; P = 0.453). Impaired hyperaemic MBFs when compared with CON were not significantly altered from those at baseline exam.
Conclusion: Long-term administration of oestrogen may contribute to maintain endothelium-dependent coronary function in PM with medically treated cardiovascular RFs.
Key Words: Cardiovascular disease prevention • Coronary circulation • Oestrogen • Endothelium • Post-menopausal women • Positron emission tomography