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Estrogen and Heart Disease
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Estrogen and Heart Disease


  Some time ago,  I overheard a conversation.  It was between a female cardiologist and a menopausal patient.  The patient was on 1.25mg. of estrogen. . The doctor told her to cut this in half as she was taking too much and it could hurt?  her cardiovascular system??.  My ears perked up as I too am on estrogen  and am taking it only to help prevent heart disease since I have a high risk factor with family history.  Now, I am not sure if she meant this was too high for the heart or cholesterol or what???  She was not talking about the breast...What is the latest findings on HRT and heart disease and cholesterol reductions?  Does this really help in these areas?  if not, I am off of them..I have also heard that estrogen patches do not give the heart protection like the pills....Also, some are on a testosterone Hormone after menopause.  If HRT really does help is some better than others?   Thank you, doctor.        Lauren.
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Dear Lauren,
There are currently two major categories for postmenopausal hormone replacement.
These are 1. estrogen therapy without progesterone(reserved only for those women
without a uterus-due to hysterectomy of course) and 2. estrogen with progesterone
therapy.  The reason that estrogen can not be used alone in a woman with an intact
uterus is that the estrogen therapy causes a significant increase in the uterine cancer
rate, thus the progesterone/estrogen combination must be used in order to protect the uterus.
          Taking higher doses of estrogen is somewhat like taking the "pill" (contraceptive pill.)
You may already know that many studies have been done on the "pill" that show there is an increased
risk of clotting of your blood on high doses of estrogen.  Many studies have also shown that the
0.625mg per day dosage of estrogen is as close to perfect as possible, that is to say, this dose
has been shown to reduce LDL(bad cholesterol) and increase HDL (good cholesterol)
and reduce other metabolic derangements that are associated with increased risk for heart disease.(see PEPI trial,published in JAMA 1995;273:199-208, can be found in any medical library)
Some 30 trials over the past 20 years that looked at the incidence of coronary artery disease in women who do and do not take estrogen
have shown that coronary artery disease in estrogen takers is approximately half that in those who do not take estrogen.  Since these trials are not
randomized(such trials are currently under way) it is believed by many that this 50%reduction in heart disease in those women taking estrogen may simply be due to bias or some kind of
healthy user effect.  Although it has not been proven as yet, there are proven benefits to taking estrogen such as decreasing the risk of
osteoporosis, preservation of skin turgor an vaginal mucosa, prevention of senility and Alzheimer's, as well as higher intellectual function and plus the metabolic benefits (better cholesterol numbers as stated above.)
Besides it is intuitive to think that at least some of that benefit(50%reduction in coronary artery disease)is due to the women actually taking estrogen.
       Now, this testosterone thing you speak of is really the progesterone that women with a uterus need take with their estrogen supplement.  NOw unfortunately,
it has been observed that the addition of progesterone seems to diminish or reverse some of the benefits of estrogen, as well some women have continued bleeding or spotting.   Of course there are very important studies underway
that compare the incidence of coronary artery disease in those on estrogen alone with those on estrogen and progesterone.  These results will be out in 1999 and there are even women in the study who are not taking any estrogen or
progesterone so as to compare the effect of all three possible regimines on coronary artery disease in women.  
      It is true that the patches are not as reliable in terms of delivery of estrogen to the body but currently there are no studies that compare this to the
estrogen taken by mouth.
       In summary, Estrogen supplementation in the postmenopausal woman is beneficial in many ways and carries a slight (less than mild) increase risk of clotting disorders (for example deep vein thrombosis) and of
breast cancer; it should be used in conjunction with progesterone if the patient has not had a hysterectomy.
If used in higher doses estrogen can be detrimental in ways that would increase coronary risk, or simply just diminish the benefits of the 0.625 dose that have been proven scientifically.
It is in your best interest to stay on the dose that you are on as this is the current recommendation.  It is noted in the literature however that some women require higher doses to control their 'hot flashes'.  Good Luck.
Information provided in the heart forum is intended for general medical informational purposes only, actual diagnosis and treatment can only be made by your physician(s)  





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