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(Circulation. 1997;96:2837-2841.)
© 1997 American Heart Association, Inc.

Articles

Short-term Anti-Ischemic Effect of 17ß-Estradiol in Postmenopausal Women With Coronary Artery Disease

Giuseppe M.C. Rosano, MD; Adriano Mendes Caixeta, MD; Sergio Chierchia, MD; Siguemituzo Arie, MD; Miguel Lopez-Hidalgo, MD; Wagner I. Pereira, MD; Filippo Leonardo, MD; Carolyn M. Webb, BSc; Fulvio Pileggi, MD; ; Peter Collins, MD

From the Istituto H San Raffaele, Roma/Milan, Italy (G.M.C.R., S.C., F.L.); the Instituto do Coração, Hospital das Clinicas, University of São Paulo, Brazil (A.M.C., S.A., M.L.-H., W.I.P., F.P.); and the Imperial College School of Medicine at the National Heart and Lung Institute, London, UK (C.M.W., P.C.).

Correspondence to Giuseppe M.C. Rosano, MD, Department of Cardiology, Ospedale San Raffaele, Via Elio Chianesi 33, 00144 Roma, Italy.

Background Short-term administration of 17ß-estradiol improves effort-induced myocardial ischemia in female patients with coronary artery disease. 17ß-Estradiol also has direct and indirect coronary vascular smooth muscle relaxing properties. The aim of the present study was to evaluate the effect of short-term administration of 17ß-estradiol on pacing-induced myocardial ischemia by means of continuous monitoring of coronary sinus pH in 16 postmenopausal female patients with coronary artery disease.

Methods and Results Patients underwent incremental atrial pacing starting at a rate of 100 bpm and increments of 20 bpm every 2 minutes up to 160 bpm before and 20 minutes after either 17ß-estradiol (1 mg sublingual, 9 patients) or placebo (sublingual, 7 patients). The time to the onset of myocardial ischemia during pacing was significantly increased by 17ß-estradiol (mean±SD, 254±36 versus 298±23 seconds; P<.02) but not by placebo (262±45 versus 256±34 seconds; P=NS) The pH shift was significantly reduced by 17ß-estradiol but not by placebo at every step of the pacing protocol. The maximum pH shift at peak pacing was significantly reduced by the administration of 17ß-estradiol by 0.022 pH units (95% CI, 0.001, 0.043; P<.04) but not by sublingual placebo (-0.002 pH units; 95% CI, -0.0073, 0.0021; P=NS). The maximum pH shift at maximum comparable pacing was also reduced by 17ß-estradiol by 0.015 pH units (95% CI, 0.012, 0.017; P<.001) but not by placebo (-0.0022 pH units; 95% CI, -0.006, 0.0015; P=NS).

Conclusions 17ß-Estradiol reduces the degree of pacing-induced myocardial ischemia in postmenopausal patients with coronary artery disease. The reduction of pacing-induced coronary sinus pH shift is consistent with an anti-ischemic effect of the hormone and is not due to preconditioning, as evidenced by the absence of improvement after placebo.

Key Words: estrogen • hormones • coronary disease • ischemia • women

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