Heart Disease and Hormones

Posted by Tony on April 28, 1999 at 17:42:12

I have idiopathic dilated cardiomyopathy.  I'm 31 years old. Male. EF of
15%. No symptoms - active.  Only difference now is that meds have dragged
me down somewhat.  Heartrate at diagnosis was a minimum of 120BPM (which
is why I went to the doctors).  Heartrate now on current meds is 95-100
in a non-exercise active state, 80-85 at dead rest on back.  BP 90/50
Meds are 100mg Coreg, 20/25 Zestoretic, 20Mg Zestril, 50mg Aldactone
(Spiro), 40mg Lasix, 10MeQ Potassium, 325mg aspirin, 100mg CoQ-10, & a
multivitamin (all total per day).
Up until Dec 98, my Coreg was 25mg per day.  On the basis of a second
opinion by a specialist, it was raised to 100mg (and the Spiro was
added).  For the first couple months, my energy level was WAY down.  I
had experienced this with increases in the Coreg previously (from 12.5
to 25), albeit on a smaller scale.  I waited it out, and it has gotten
better.  I still can't do significant treadmill exercise as before (say,
2 miles at a fast walk).  However, I have learned what I should and
shouldn't do, and I just don't exhaust myself too much.
My questions are:
  Is it reasonable to expect that a higher dose of Coreg this high will
give me better results than say, 50mg?  I only ask because a) this much
Coreg, while I have gotten used to it, still causes muscles to ache more
than lower doses, and b) the first time I tried to fill my perscription
at the pharmacy, the pharmicist needed verification to dispense that
dosage - said it was higher than the recommended dose.  If there is
a reasonable expectation that it will be more effective than 50mg, then
I feel the inconveniences I described as worth it.  If not, then I'm
gonna lower it.
  The second question revolves around HRT and heart disease.  I have read
several studies that seem to indicate that benefits have been shown in
female patients with heart disease that take estrogens (these are
primarily post-menopausal women).  Some studies show an increased risk
in the first year of heart related episodes, and decreased risk
thereafter.  Some show no benefit.  Most show a decrease in lipid levels.
  I understand that Aldactone, an anti-androgen, is given to work in
conjunction with ACE inhibitors, thus lowering blood pressure.  
  My question is this:  Ignoring the normally unwanted side-effects that
HRT regimens would have in a male, is there any medical opinion, studies,
or anecdotal evidence that would show a benefit of HRT towards heart
disease?
  Is there any correlation between testosterone levels and vascular constriction?
Thanks.
Posted by CCF CARDIO MD - DLB on April 30, 1999 at 09:47:31
Dear Tony
I am not sure what the point is of the higher dose of Coreg, if it makes you feel so bad overall. You should discuss with your doctor the possibility of decreasing the dose back down to 50mg.
The exact relationship between estrogen replacement therapy and heart disease is still very unclear. There is no evidence currently that giving men estrogen would decrease their chances of heart disease. Estrogen does appear to have a beneficial effect on vascular reactivity; testosterone does not appear to be a vasoconstrictor under normal circumstances.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.