Adding Progestins May Negate Heart Protection From Estrogen Replacement Therapy

ular reactivity.

To determine the effect of ERT plus progestins on the blood vessels, researchers performed a study that divided 100 postmenopausal women into two groups; one received ERT plus progestins and the other received no therapy.

After the women had been taking the ERT plus progestins for about three years, researchers tested blood vessel reactivity. The test involves inflating a blood pressure cuff on the forearm to block the blood vessel. After about four minutes, the cuff is deflated and images of the blood vessels are recorded by ultrasound as the blood rushes into the vessel. A similar degree of vessel dilation was seen in both groups, indicating that ERT plus progestins did not improve vascular reactivity, Dorup reports.

"In earlier studies, estrogen alone would beneficially alter vascular reactivity, and this was thought to be one way it lowered risk of heart disease. But we found that there is no difference between those receiving HRT plus progestins and no treatment. Progestin may impair the positive effects normally seen by estrogen alone," adds Dorup.

According to Vogel, larger studies, such as the Women's Health Initiative, may help determine whether ERT with progestins can reduce the death rate of cardiovascular disease. "These studies are important because the current study just looked at the endothelium and not death rates," says Vogel.

"However, we still don't know if the endothelium function is an accurate predictor for increased risk of death from cardiovascular disease, although other research has documented that it signals the first stages of atherosclerosis," he says.

In atherosclerosis, blood vessels narrow due to blockages from cholesterol or blood clots, setting the stage for a heart attack or stroke.

Previous studies have found that women taking estrogen lowered their risk of heart disease by 3

Contact: Brian Henry
American Heart Association

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