How does HT in recent and 10+ years past menopause affect atherosclerosis progression?
Secondary analysis of ELITE trial data among 596 women in early (<6 years) and late (≥10 years) postmenopause indicates that estradiol (E2) plasma levels resulting from oral E2 administration were inversely associated with atherosclerosis progression in the women in early menopause, but positively associated with atherosclerosis progression in those in late menopause
Bottom line. E2 levels resulting from administration of oral estradiol were inversely associated with atherosclerosis progression in women in early menopause, but they were positively associated with progression in late postmenopause participants.
WHAT THIS EVIDENCE MEANS FOR PRACTICE
These new findings from a posttrial analysis of ELITE data provide yet further support for the hormone therapy (HT) “timing hypothesis,” which postulates that HT slows atherosclerosis progression in recently menopausal women but has neutral or adverse effects in women who are at least a decade past menopause onset. As the authors suggest, the favorable vascular effects of E2 appear limited to those women (most often in early menopause) who have not yet developed atherosclerosis. Whether or not HT should be considered for cardioprotection remains unresolved (and controversial). By contrast, these data, along with findings from the Women’s Health Initiative,3 provide reassurance regarding the cardiovascular safety of HT when prescribed for recently menopausal women with bothersome vasomotor symptoms.
ANDREW M. KAUNITZ, MD
References
1. Hodis HN, Mack WJ, Henderson VW, et al; for the ELITE Research Group. Vascular effects of early versus late postmenopausal treatment with estradiol. N Engl J Med. 2016;374;1221-1231.
2. Sriprasert I, Hodis HN, Karim R, et al. Differential effect of plasma estradiol on subclinical atherosclerosis progression in early versus late postmenopause. J Clin Endocrinol Metab. 2019;104:293-300. doi:10.1210/jc.2018-01600.
3. Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA. 2013;310:1353-1368.
