Effects of Estrogen Replacement on the Progression of Coronary-Artery Atherosclerosis
Open accessAbstract
BACKGROUND: Heart disease is a major cause of illness and death in women. To understand better the role of estrogen in the treatment and prevention of heart disease, more information is needed about its effects on coronary atherosclerosis and the extent to which concomitant progestin therapy may modify these effects. METHODS: We randomly assigned a total of 309 women with angiographically verified coronary disease to receive 0.625 mg of conjugated estrogen per day, 0.625 mg of conjugated estrogen plus 2.5 mg of medroxyprogesterone acetate per day, or placebo. The women were followed for a mean (+/-SD) of 3.2+/-0.6 years. Base-line and follow-up coronary angiograms were analyzed by quantitative coronary angiography. RESULTS: Estrogen and estrogen plus medroxyprogesterone acetate produced significant reductions in low-density lipoprotein cholesterol levels (9.4 percent and 16.5 percent, respectively) and significant increases in high-density lipoprotein cholesterol levels (18.8 percent and 14.2 percent, respectively); however, neither treatment altered the progression of coronary atherosclerosis. After adjustment for measurements at base line, the mean (+/-SE) minimal coronary-artery diameters at follow-up were 1.87+/-0.02 mm, 1.84+/-0.02 mm, and 1.87+/-0.02 mm in women assigned to estrogen, estrogen plus medroxyprogesterone acetate, and placebo, respectively. The differences between the values for the two active-treatment groups and the value for the placebo group were not significant. Analyses of several secondary angiographic outcomes and subgroups of women produced similar results. The rates of clinical cardiovascular events were also similar among the treatment groups. CONCLUSIONS: Neither estrogen alone nor estrogen plus medroxyprogesterone acetate affected the progression of coronary atherosclerosis in women with established disease. These results suggest that such women should not use estrogen replacement with an expectation of cardiovascular benefit.
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The ERA trial was a randomized, controlled trial evaluating the effect of hormone replacement therapy on angiographic progression of atherosclerosis.
“The Estrogen Replacement and Atherosclerosis (ERA) trial was a randomized, controlled trial that evaluated the effect of hormone replacement therapy on angiographic progression of atherosclerosis.”
From Diabetes, the Metabolic Syndrome, and Angiographic Progression of Coronary Arterial Disease in Postmenopausal Women (2006) · cites this paper as [13]
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Self-citation
- Authors
- Herrington, D. M., Reboussin, D. M., Brosnihan, K. B., Sharp, P. C., Shumaker, S. A., Snyder, T. E., Furberg, C. D., Kowalchuk, G. J., Stuckey, T. D., Rogers, W. J., Givens, D. H., & Waters, D.
- Affiliations
- Wake Forest University Health Sciences (US)
- Carolinas Medical Center (US)
- University of Alabama at Birmingham (US)
- San Francisco General Hospital (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2000-08-24
- Volume
- 343
- Issue
- 8
- Pages
- 522-529
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2332056249
- Cited by
- 1,242
- References
- 33
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 9 · 2023: 8 · 2022: 10 · 2021: 13 · 2020: 10 · 2019: 10 · 2018: 14 · 2017: 19 · 2016: 17 · 2015: 21 · 2014: 15 · 2013: 29 · 2012: 14
- FWCI
- 133.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (U01 HL 45488)
- National Center for Research Resources (M01RR-07122, M01RR007122)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Estrogen and related hormone effects
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- estrogen replacement therapy, coronary artery disease, atherosclerosis progression, medroxyprogesterone acetate, conjugated estrogens, coronary artery disease in women, LDL cholesterol, HDL cholesterol, coronary artery diameter, cardiovascular events, menopause
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Cholesterol, Coronary Disease, Double-Blind Method, Drug Therapy, Combination, Estrogens, Conjugated (USP), Female, Humans, Middle Aged, Triglycerides, Estrogen Replacement Therapy, Coronary Angiography, Medroxyprogesterone Acetate, Postmenopause, Disease Progression, Hormone Replacement Therapy
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