Hormone Replacement Therapy Linked to Hard Arteries

Postmenopausal women with lower serum estrogen levels had a greater volume of paracardial fat—meaning fat that accumulates outside the pericardium.

Hormone replacement therapy was found to affect the accumulation of heart fat, stated study published today in the Journal of the American Heart Association and conducted by Pitt researchers. Heart fat is a new risk factor for cardiovascular disease //in midlife women.

Importantly, they found that the formulation and delivery route of hormones—whether as a pill taken orally or a patch placed on the skin—mattered when it came to the types of fat deposits women developed and whether those fat deposits translated to hardening of the arteries. “We cannot treat all menopause hormone therapy types the same,” said study lead author Samar El Khoudary, Ph.D., M.P.H., associate professor of epidemiology at Pitt Public Health. “We’re adding to the recognized list of cardiovascular-related effects of menopause hormone therapy by showing a novel cardiovascular risk factor that’s specific to menopausal women also is affected by hormone therapy.”

Hormone Replacement Therapy
Hormone Replacement Therapy can be likened to an ‘oasis in the desert’ for women in the throes of menopause.

‘New study reinforces the importance of tailoring hormone therapy to each patient, based on her individual risk factors for cardiovascular disease.’

Menopause commonly comes with a host of challenges—including hot flashes, night sweats, vaginal dryness and increased risk of osteoporosis—and hormone therapy is the primary treatment. The researchers used data from 474 healthy women ages 42 through 58 enrolled in the Kronos Early Estrogen Prevention Study (KEEPS), which was a multi-center, randomized, placebo-controlled clinical trial of the effects of oral conjugated equine estrogens and transdermal 17-beta estradiol on atherosclerosis progression. Participants enrolled between 2005 and 2008 and were followed for four years.

“The KEEPS trial is unique because it focuses on younger women close to the onset of menopause, and tested both a pill and patch formulation of menopausal hormone therapy,” said study coauthor JoAnn Manson, M.D., Dr.P.H., physician at Brigham and Women’s Hospital and Harvard Medical School. “This allowed us to see the effects of different types of hormone therapy and whether the route of delivery—oral or through the skin—affected heart health in otherwise healthy women.” An earlier study from El Khoudary’s group showed that postmenopausal women with lower serum estrogen levels had a greater volume of paracardial fat—meaning fat that accumulates outside the pericardium—and also higher rates of coronary artery calcification, compared to premenopausal women.

El Khoudary and her team hypothesized that menopause hormone therapy would be protective against heart fat accumulation, but what they found was not so simple. The type of hormone therapy and route of administration mattered.

Peripheral Artery Disease (PAD) - Causes, Symptoms, Diagnosis, Treatment & Prevention
Peripheral arterial disease is a chronic condition marked by deposition of fatty plaque within arteries of the body and reduction in blood supply.

The transdermal estradiol patch—generally considered to be safer—compounded the harmful effects of paracardial fat deposition on coronary artery calcification (CAC) progression. In contrast, women on the estrogen pill were less likely to see increases in heart fat in the epicardial space immediately surrounding the heart or worsening CAC.

“That was surprising,” El Khoudary said. “The patch is thought to be safer because it’s not systemic, just topical, and it doesn’t have an impact on inflammation or triglyceride levels like oral hormones.”