Estrogen status is associated with coronary calcium ("hardening of the arteries") and plaque area independent of age and coronary heart disease risk factors, the researchers reported. Estrogen may modulate the calcium content of atherosclerotic plaques, as well as plaque area and may slow the progression of atherosclerosis in women.
The study appears in the March 4 issue of the Journal of Endocrinology and Metabolism.
Observational studies suggest that postmenopausal women treated with estrogen replacement therapy have a significantly reduced risk of coronary heart disease and less extensive coronary calcification than untreated women. However, the role of estrogen in the primary and secondary prevention of coronary heart disease remains controversial as its cardioprotective effects have not been confirmed in prospective clinical trials in women with established heart disease.
"We still don’t know if estrogen is beneficial against heart disease, but this study suggests it might slow the progression of atherosclerosis in women," said Lorraine Fitzpatrick, M.D., a Mayo Clinic endocrinologist and the principal investigator of the study.
"Our data indicate a strong negative association between estrogen status and both coronary calcium and plaque, and suggest that coronary calcification and plaque formation may progress at different rates in the presence of estrogen," Dr. Fitzpatrick said. "In light of the recent controversies related to findings of estrogen replacement therapy in prospective clinical trials, understanding the role of estrogen in the pathogenesis of the calcified, atherosclerotic plaque has become increasingly relevant."
In the study, coronary arteries were obtained at autopsy from 56 white women age 18-98 years, 46 postmenopausal and 10 premenopausal. They were excluded if they had coronary stents, coronary artery bypass surgery, or were a medical-legal case. Medical records were reviewed for demographics, coronary heart disease risk factors, menstrual status, and use of estrogen replacement therapy.
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Journal
Journal of Endocrinology and Metabolism