estrogen/heart

  From a cardiac standpoint, is it usually recommended that women  take estrogen after menopause?  I have severe mv regurgitation and could need surgery in the future.  In the past gyn has not felt it necessary, and until this year, it has not been suggested by any cardiologist.  Thank you! Your replies are always appreciated.

[CCF Cardio MD - MTR]

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Dear Jan, thank you for your question.  You touch on an important area of cardiovascular disease - estrogen replacement.  From a cardiac standpoint, the reason to start estrogen replacement is to reduce the risk of developing coronary artery disease and a heart attack.  So far, the data regarding this subject have been mixed so there currently is no firm recommendation on whether women should take estrogen to reduce their risk of developing coronary disease.  A recently published trial called the HERS trial (published in the Journal of the American Medical Association in the last 2 months) randomized women with known coronary disease to estrogen replacement (with progesterone) or placebo.  After > 4 years of follow-up, no effect on cardiac outcomes was noted in the estrogen group despite favorable changes in the  women's lipids (increased HDL and decreased LDL cholesterol).   A much larger trial is being conducted by the NIH now to definitively answer this question, so we are not making recommendations based on the HERS trial results.  By modifying cholesterol levels, estrogen is thought to reduce the plaque burden in coronary arteries and to stabilize potentially unstable plaques.  In addition to positive cardiovascular effects, estrogen helps to prevent osteoporosis.  There are notable side effects, however.  First, estrogen can increase the risk of developing a venous thrombosis (clot) in the veins of the legs which could cause a pulmonary embolus to develop.  Second, estrogen replacement without progesterone can markedly increase the risk of endometrial cancer in women who have not had a hysterectomy.  Third, estrogen can increase the risk of breast cancer (especially in women with a family history of breast cancer).  Thus, estrogen replacement is a controversial area, as you can see.  I assume that you have mitral regurgitation from your question.  Estrogen replacement will not improve this condition nor will it have any effect on the function of your cardiac valves after surgery.  However, for the aforementioned reasons, estrogen replacement may benefit you.   I suggest that you discuss the pros and cons with your cardiologist and then talk to your gynecologist again.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
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.