Adding Progestins May Negate Heart Protection From Estrogen Replacement Therapy

DALLAS, April 7 -- Adding progestins to estrogen replacement therapy may weaken some of its beneficial effects in helping women prevent heart attacks, according to a study reported in today's Circulation: Journal of the American Heart Association.

Estrogen replacement therapy (ERT) is used to relieve symptoms of menopause and may help protect against heart disease. Progestins are combined with estrogen because replacement therapy using estrogen alone is associated with increased risk of uterine cancer. But progestins may subtract some of the heart protection from ERT, according to a study by Keld Sorensen, M.D., associate professor in cardiology and Inge Dorup, M.D., D.M.Sc., associate professor in cardiology from the cardiology department at Skejby University Hospital, Aarhus, Denmark. The research team also included a group of investigators from the department of endocrinology and metabolism at Aarhus County Hospital.

In an accompanying editorial appearing in Circulation: Journal of the American Heart Association, Robert Vogel, M.D., says the study "raises a flag that progestins may undo some of the cardiovascular benefits of ERT."

"The study is important because it indicates that there is a difference between estrogen and estrogen plus progestin," says Vogel, Herbert Berger professor of medicine and head of the division of cardiology at the University of Maryland School of Medicine, Baltimore.

Estrogen acts like a "fountain of youth," helping the blood vessels' inner layer -- the endothelium -- remain flexible and be able to "relax and expand" in response to the body's need for blood. This property, called vascular reactivity, often declines after age 50, making blood vessels stiff and less effective in delivering blood to the body's tissues. Excess cholesterol in the blood and high blood pressure can damage the endothelium, resulting in a decrease in vasc

Contact: Brian Henry
American Heart Association

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