Herz

, Volume 22, Issue 3, pp 151–157

Estrogens for prevention of coronary heart disease

  • T. Meinertz
Koronare Atherosklerose

Summary

In recent years, reports of favourable effects of estrogen therapy on cardiovascular morbidity and mortality have led to enthusiasm for widespread use of estrogens by postmenopausal women. Guidelines for estrogen therapy issued by the American College of Physicians include the statement “Women who have coronary heart disease are likely to benefit from hormone therapy”. What evidence support this recommendation? More than 30 observation studies have examined the effect of estrogen replacement therapy on cardiovascular event and all cause mortality. In addition there have been 13 case controlled studies. The majority showed lower morbidity and mortality from coronary heart disease among users of postmenopausal estrogens than among nonusers. Recently, 2 meta-analyses estimated the reduction in coronary heart disease associated with estrogen use to be in the range of 35 to 44%, respectively. All of these observational studies share a fatal flaw: Women who take estrogens are different from women who do not. Some differences have been measured, others have not. Women who take estrogens are on average better educated, healthier, have higher incomes and have better access to health care. These differences rather than the estrogens may account for much of the lower risk of heart disease. At this time we cannot tell from these observational studies what the real benefit of estrogens on coronary heart disease might be. Estrogen replacement therapy is not without risk. Estrogens increase the risk of endometrial carcinoma approximately 6-fold, an effect that is eliminated by the addition of progestins. Controversy continues over whether estrogen replacement increases the risk of breast cancer. A number of prospective randomized studies are now under way that will establish whether estrogen replacement therapy definitely reduces the risk of cardiovascular disease in women with and without coronary lesions and whether it increases the risk of breast cancer. Until the results of these trials are available claims on the definite usefulness of hormone supplementation to prevent coronary heart disease in postmenopausal women remain premature. In the light of the probable usefulness estrogen replacement therapy for the prevention of cardiovascular events should be recommended for women with increased risk for or definitively proven coronary heart disease.

Key Words

Estrogens Prevention Coronary heart disease 

Östrogene zur Prävention der koronaren Herzkrankheit?

Zusammenfassung

In den letzten Jahren werden zunehmend Frauen in der Menopause mit Östrogenen behandelt. Dies geschieht nicht nur zur Therapie klimakterisch bedingter Beschwerden oder zur Behandlung der Osteoporose, sondern auch zur Prävention der koronaren Herzkrankheit. Die letztgenannte therapeutische Praxis wird mit den Ergebnissen zahlreicher Beobachtungs-und Fallkontrollstudien begründet. In der Mehrzahl ergeben diese Studien einen günstigen Effekt der Östrogensubstitution auf verschiedene kardiovaskuläre Endpunkte sowie — in einzelnen Studien — auch auf die Mortalität. Es zeigte sich tendenziell, daß insbesondere Frauen mit manifester koronarer Herzkrankheit von dieser Therapie profitieren. Zur Vermeidung einer endometrialen Hyperplasie und endometrialer Karzinome wird die Östrogensubstitution mit einer Gestagengabe kombiniert. Bis heute ist der Nutzen dieser Kombinationstheraple jedoch nicht durch Ergebnisse prospektiver randomisierter Studien gesichert. Derartige Studien werden derzeit sowohl bei klinisch herzgesunden- als auch koronarkranken postmenopausalen Frauen durchgeführt. In Anbetracht potentieller Risiken sollte man, bis die Ergebnisse dieser Studien vorliegen, mit einer generellen und ungezielten Östrogen- bzw. Gestagensubstitution zurückhaltend sein. Sie kommt derzeit nur für koronarkranke Frauen oder solche mit deutlich erhöhtem Risiko für eine koronare Herzkrankheit in den ersten Jahren der Menopause in Betracht. Andere Indikationen für eine Östrogen- bzw. Gestagentherapie in der Menopause sind davon unberührt.

Schlüsselwörter

Östrogene Prävention Koronare Herzkrankheit 

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Copyright information

© Urban & Vogel 1997

Authors and Affiliations

  • T. Meinertz
    • 1
  1. 1.Abteilung für KardiologieMedizinische Klinik und Poliklinik der UniversitätHamburg

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