Conjugated equine estrogens and peripheral arterial disease risk: The Women's Health Initiative - 18/08/11

Doi : 10.1016/j.ahj.2005.09.005

Judith Hsia, MD ^a,^⁎ , Michael H. Criqui, MD, MPH ^b, David M. Herrington, MD ^c, JoAnn E. Manson, MD, DrPH ^d, LieLing Wu, MS ^e, Susan R. Heckbert, MD, PhD ^f, Matthew Allison, MD, MPH ^b, Mary McGrae McDermott, MD ^g, Jennifer Robinson, MD, MPH ^h, Kamal Masaki, MD ⁱ
for the Women's Health Initiative Research Group
^a Department of Medicine, George Washington University, Washington, DC
^b Department of Family and Preventive Medicine, University of California at San Diego, San Diego, CA
^c Department of Medicine, Wake Forest University, Winston-Salem, NC
^d Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
^e Fred Hutchinson Cancer Research Center, Seattle, WA
^f Department of Epidemiology, University of Washington, Seattle, WA
^g Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
^h Departments of Epidemiology and Medicine, College of Public Health, University of Iowa, Iowa City, IA
ⁱ Department of Geriatric Medicine, University of Hawaii, Honolulu, HI

^⁎Reprint requests: Judith Hsia, MD, 2150 Pennsylvania Ave NW #4-414, Washington, DC 20037.

The National Heart, Lung, and Blood Institute funds the Women's Health Initiative.

Résumé

Background

Estradiol reduced progression of ultrasonographic carotid disease in a randomized trial. No trials of unopposed estrogen for prevention of lower extremity arterial disease or aortic aneurysm have been conducted.

Methods

The Estrogen Alone trial randomized 10739 postmenopausal women with prior hysterectomy, mean age 63.6 ± 7.3 years, to conjugated equine estrogens (CEE 0.625 mg/d) or placebo and documented health outcomes over an average of 7.1 ± 1.6 years.

Results

A trend toward increased risk of peripheral arterial events with CEE was observed (hazard ratio [HR] 1.32, 95% CI 0.99-1.77). Carotid arterial events (HR 1.19, 95% CI 0.82-1.74), lower extremity arterial events (HR 1.41, 95% CI 0.86-2.32), and abdominal aortic aneurysm (HR 2.40, 95% CI 0.92-6.23) were more frequent, but not individually significant, in the CEE group. However, the composite of lower extremity arterial disease/abdominal aortic aneurysm was significantly more frequent among women assigned to CEE (HR 1.63, 95 % CI 1.05-2.51). In subgroup analyses, no clear pattern of risk with CEE was apparent by age or by time since menopause.

Conclusions

Unopposed CEE conferred no protection against peripheral arterial disease among generally healthy postmenopausal women; in fact, there was a suggestion of increased risk.

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Vol 152 - N° 1

P. 170-176 - juillet 2006 Retour au numéro

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Conjugated equine estrogens and peripheral arterial disease risk: The Women's Health Initiative - 18/08/11

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Background

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Conclusions

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