Circulation, Vol 88, 2163-2171, Copyright © 1993 by American Heart Association
TA Manolio, CD Furberg, L Shemanski, BM Psaty, DH O'Leary, RP Tracy and TL Bush
BACKGROUND. Postmenopausal estrogen replacement therapy has been associated
with favorable levels of cardiovascular disease risk factors, but these
associations and the relations between estrogen use and subclinical disease
have not been examined in large samples of older women. METHODS AND
RESULTS. Present and past estrogen use was ascertained in 2955 women >
or = 65 years old in the Cardiovascular Health Study, a study of risk
factors for coronary heart disease and stroke in the elderly. Present
estrogen use was reported by 12% of these women and past use by an
additional 26.5%. Estrogen use (past or present) was strongly associated
with lower low-density lipoprotein cholesterol, fibrinogen, glucose,
insulin, obesity, and age and higher high-density lipoprotein cholesterol
and socioeconomic status (all P < .0001). Estrogen users also had lower
levels of subclinical disease as measured by carotid intimal-medial
thickness, carotid stenosis grade, ECG left ventricular mass, and Doppler
mitral peak flow velocities (each P < .02). Relations were similar in
younger and older women (65 to 74 versus > or = 75 years) and smokers
and nonsmokers and were unchanged after women with poor medication
compliance were excluded. After adjustment for other factors, estrogen use
was associated with decreased carotid wall thickness, although this
association was of borderline significance after further adjustment for
lipids. CONCLUSIONS. Postmenopausal estrogen use in this sample of older
women was associated with favorable cardiovascular disease risk factor
profiles and with lower measures of subclinical disease. These findings
suggest that postmenopausal estrogen use may be associated with lower risk
of cardiovascular disease in women well into the eighth decade of life.
ARTICLES
Associations of postmenopausal estrogen use with cardiovascular disease and its risk factors in older women. The CHS Collaborative Research Group
Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md. 20892.
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