Journal of Hypertension.
21(6):1145-1149, June 2003.
Honisett, Suzy Y a,b; Pang, Ben a; Stojanovska, Lily b; Sudhir, Krishnankutty a; Komesaroff, Paul A a
Abstract:
Background: The protective functions of oestrogen therapy alone on cardiovascular risk parameters are well established; however, the action of progesterone on vascular parameters in an oestrogen-deprived environment is less clear.
Objectives: To examine the effects of progesterone alone on vascular function and hormone levels in postmenopausal women.
Design: In a randomized, double-blind, cross-over design study, 20 healthy postmenopausal women were tested before and after 6 weeks of treatment with micronized progesterone (100 mg/daily) and matching placebo.
Methods: Tests included measurement of sex hormones and gonadatropin levels, lipids and measures of surrogate markers of vascular function including, blood pressure, flow-mediated dilation of the brachial artery, systemic arterial compliance and cutaneous vascular reactivity.
Results: The mean (+/- SEM) age of subjects was 56.4 +/- 2.7 years and the average body mass index at the baseline visit was 27.1 +/- 1.0 kg/m2. Progesterone levels increased as a result of progesterone treatment (0.9 +/- 0.2 to 9.5 +/- 2.3 nmol/l, P = 0.001), whereas follicle-stimulating hormone levels decreased (75.1 +/- 11.4 to 67.6 +/- 10.0, P = 0.001). Systemic arterial compliance, flow mediated dilation, cutaneous vascular reactivity, blood pressure, body mass index, plasma levels of cholesterol, lipids and oestrogen were unchanged.
Conclusions: We conclude that progesterone given without oestrogen does not adversely affect vascular function in postmenopausal women.
(C) 2003 Lippincott Williams & Wilkins, Inc.
http://www.jhypertension.com/pt/re/jhypertension/abstract.00004872-200306000-00014.htm;jsessionid=G94BpGq9vTTMn7hRKSFxjvBpNzjzZvwTfPQCVvr3ftxngKQB8FLM!-1465501618!-949856144!8091!-1
Exp Clin Endocrinol Diabetes 2003; 111: 267-273
DOI: 10.1055/s-2003-41753
One Year Follow-Up of Hormone Replacement Therapy with Percutaneous Estradiol and Low-Dose Vaginal Natural Progesterone in Women with Mild to Moderate Hypertension
P. M. Spritzer 1,2,D. Vitola 3,L. C. Vilodre 1,2,M. C. O. Wender 1,F. M. Reis 4,S. Ruschel 1,I. Castro 3
1Gynecological Endocrinology Unit, Division of Endocrinology, University Hospital, Brazil
2Department of Physiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
3Cardiology Institut, Porto Alegre, Brazil
4Medical School of Barbacena, Brazil (formerly at Department of Physiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil)
Abstract
Objective
The effects of natural estradiol and progesterone replacement therapy on lipoprotein and cardiovascular parameters were assessed in 20 postmenopausal women with mild to moderate systemic arterial hypertension.
Design
After confirming hypertension in the absence of antihypertensive treatment, blood pressure control was achieved by administration of amlodipine at individually adjusted doses. Hormone replacement therapy (HRT) was introduced in a cyclic regimen (21 of 28 days) with percutaneous estradiol (1.5 mg/day) and vaginal micronized progesterone (100 mg/day).
Results
Blood pressure and mean heart rate remained unchanged during HRT. Serial echocardiograph scans showed no change in left ventricle mass, but a significant reduction in the thickness of the left ventricular posterior wall was observed. During treatment, patients showed little variation in total cholesterol levels (baseline: 199 ± 10 mg/dl, 12 months: 202 ± 11 mg/dl), as well as in high-density lipoprotein (53 ± 2 to 50 ± 3 mg/dl), low-density lipoprotein (122 ± 10 to 118 ± 11 mg/dl), and triglycerides (111 ± 13 to 126 ± 13 mg/dl). A subgroup of 10 patients with initial total cholesterol levels > 200 mg/dl responded to HRT with a slight but significant decrease of cholesterol levels after 12 months (265 ± 10 to 237 ± 12 mg/dl, p < 0.05, repeated measures ANOVA). HRT did not change mean antithrombin III levels and affected neither plasma renin activity nor aldosterone levels.
Conclusion
These results suggest that the proposed HRT regimen with percutaneous estradiol associated with low-dose vaginal micronized progesterone could be a safe alternative for postmenopausal women with hypertension at least during the period required to treat menopausal symptoms.
http://www.thieme-connect.com/ejournals/abstract/eced/doi/10.1055/s-2003-41753;jsessionid=3290A0DA455A7D3318E2D4B337498670.jvm1
Published online before print July 11, 2002, doi:10.1161/01.ATV.0000029226.45915.A7
Arteriosclerosis, Thrombosis, and Vascular Biology. 2002;22:1459.
© 2002 American Heart Association, Inc.
Atherosclerosis and Lipoproteins
Effects of Continuous Combined Hormone Replacement Therapy on Inflammation in Hypertensive and/or Overweight Postmenopausal Women
Kwang Kon Koh ;Jeong Yeal Ahn ;Dong Kyu Jin ;Byung-Koo Yoon ;Hyung Sik Kim ;Dae Sung Kim ;Mi-Seung Shin ;Ji Won Son ;In Suck Choi ;Eak Kyun Shin
From the Departments of Cardiology (K.K.K., K.K.J., M.-S. S., J.W.S., I.S.C., E.K.S.), Clinical Pathology (J.Y.A.), Obstetrics and Gynecology (B.K.Y.) (Samsung Medical Center, Sungkyunkwan University), Radiology (H.S.K.), and Preventive Medicine (Biostatistics) (D.S.K.), Gachon Medical School, Incheon, Korea
Address correspondence to Kwang Kon Koh, MD, FACC, FAHA, Professor of Medicine, Director, Vascular Medicine and Atherosclerosis Unit, Division of Cardiology, Gil Heart Center, Gachon Medical School, 1198 Kuwol-dong, Namdong-gu, Incheon, Korea 405-760. E-mail kwangk@ghil.com
Objective- We observed that estrogen did not show cardioprotective benefits in type 2 diabetic postmenopausal women. We hypothesized that hypertensive and/or overweight women may be less likely to realize cardiovascular benefits from estrogen.
Methods and Results- We administered micronized progesterone (MP) 100 mg or medroxyprogesterone acetate (MPA) 2.5 mg with conjugated equine estrogen (CEE) 0.625 mg daily during 2 months to 35 hypertensive and/or overweight postmenopausal women with a randomized, double-blind, crossover design. With significant changes of lipoproteins, CEE+MP or MPA significantly improved flow-mediated dilation and reduced plasma E-selectin, intercellular adhesion molecule type-1, monocyte chemoattractant protein-1, and tumor necrosis factor- levels ( P<0.001, P<0.001, P=0.021, P<0.001, and P<0.001 by ANOVA, respectively), but not C-reactive protein and fibrinogen levels. Of note, there were no significant differences between each therapy regarding these effects. However, the magnitude of improvement of flow-mediated dilation in these women was less than in healthy postmenopausal women and more than in diabetic postmenopausal women reported by our previous studies. The effects of CEE+MP or MPA on inflammatory markers were comparable to healthy postmenopausal women, but not comparable to diabetic postmenopausal women.
Conclusions- Estrogen combined with synthetic progestin significantly improved flow-mediated brachial artery dilator response and reduced inflammation markers in hypertensive and/or overweight women, comparable to estrogen combined with natural progesterone.
http://intl-atvb.ahajournals.org/cgi/content/abstract/22/9/1459
J Am Coll Cardiol, 2000; 36:2154-2159
© 2000 by the American College of Cardiology Foundation
Natural progesterone, but not medroxyprogesterone acetate, enhances the beneficial effect of estrogen on exercise- induced myocardial ischemia in postmenopausal women
Giuseppe M. C. Rosano, MD, FACC *,Carolyn M. Webb, PhD ,Sergio Chierchia, MD, FACC *,Gian Luigi Morgani, MD *,Michele Gabraele, MD *,Phillip M. Sarrel, MD ,Dominique de Ziegler, MD and Peter Collins, MD, FACC
*Department of Cardiology, Ospedale San Raffaele, Rome and Milan, Italy
Cardiac Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, and Royal Brompton and Harefield NHS Trust, London, United Kingdom
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut, USA
Columbia Laboratories, Paris, France
Manuscript received October 28, 1999; revised manuscript received July 6, 2000, accepted August 18, 2000.
Reprint requests and correspondence: Dr. Peter Collins, Cardiac Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, Dovehouse Street, London SW3 6LY, United Kingdom
OBJECTIVES
We sought to compare the effects of estrogen/transvaginal progesterone gel with estrogen/medroxyprogesterone acetate (MPA) on exercise-induced myocardial ischemia in postmenopausal women with coronary artery disease or previous myocardial infarction, or both.
BACKGROUND
Estrogen therapy beneficially affects exercise-induced myocardial ischemia in postmenopausal women; however, women with an intact uterus also take progestin to protect against uterine malignancies. The effects of combination estrogen/progestin therapy on myocardial ischemia are unknown.
METHODS
Eighteen postmenopausal women (mean ± SD age 59 ± 7 years) were given 17-beta-estradiol in single-blinded manner for four weeks (1 mg/day for three weeks then 2 mg/day for one week). Estradiol (2 mg/day) was then continued, and the patients were randomized (double-blind) for 12 days to either transvaginal progesterone gel (90 mg on alternate days) and oral MPA placebo (10 mg/day), or vice versa. After another two weeks on estradiol alone, the patients crossed over to progestin treatment and repeated the protocol on the opposite treatment. Patients underwent treadmill exercise testing after each estradiol phase and at day 10 of each progestin phase.
RESULTS
Exercise time to myocardial ischemia increased after the first estrogen phase as compared with baseline (mean difference with 95% confidence interval [CI]: 72 s [34 to 110], p = 0.001), and was increased by combination estradiol/progesterone therapy as compared with estradiol/MPA therapy (92 s [35 to 149], p = 0.001)). Two patients (11%) were withdrawn while taking estradiol/MPA owing to unstable angina.
CONCLUSIONS
Combination estrogen/transvaginal progesterone gel increases exercise time to myocardial ischemia, as compared with estrogen/MPA. These results imply that the choice of progestin in women at higher cardiovascular risk requires careful consideration.
http://content.onlinejacc.org/cgi/content/abstract/36/7/2154
