Gene enhances effects of estrogen on good cholesterol

WINSTON-SALEM, N.C. A genetic variant seems to determine how well womens good cholesterol responds to estrogen therapy, reports David Herrington, M.D., from Wake Forest University Baptist Medical Center in this weeks New England Journal of Medicine. The finding could help doctors identify women most likely to gain a heart benefit from hormone therapy.

If our findings hold true, a simple gene test could help doctors and women make better decisions about the use of hormone replacement therapy for prevention of heart disease, said Herrington, a professor of cardiology.

In an analysis of 309 women with heart disease who took hormone replacement therapy or placebo, Herrington found that women with a common mutation in the estrogen receptor alpha gene had dramatic increases in high-density lipoprotein (HDL), or the good cholesterol. The increase in HDL was more than twice as much as in women without the gene variant, said Herrington.

These findings are important since increases in HDL cholesterol are believed to be helpful to prevent heart disease, especially in women. Herrington found that 18 percent of women had a genetic predisposition to high levels of HDL cholesterol when taking estrogen. The HDL increase was dramatic it was two or three times what is normally achieved with cholesterol drugs used to raise HDL.

More research is needed to see if the higher HDL levels translate into fewer heart attacks, said Herrington. We also need to know if women with the gene variant are more sensitive to estrogens other effects. But, this finding is exciting because it shows the potential for doctors to use genetic testing to improve decisions about drug therapy.

There are similar reports that different gene variants influence the effects of other commonly used medications, such as cholesterol lowering drugs and drugs to treat high blood pressure and asthma.

Previous studies of cholesterol drugs show that raising HDL to t

Contact: Karen Richardson
Wake Forest University Baptist Medical Center

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