Phoenix—Women who were prescribed estradiol within 6 years after the onset of menopause appeared to be at lower risk of atherosclerosis, although similar benefits weren’t found in those who waited 10 years to initiate hormone therapy.

That is based on preliminary research presented at the American Heart Association’s Epidemiology, Prevention, Lifestyle, and Cardiometabolic Health Scientific Sessions 2020.

“Atherosclerosis is a major cause of heart disease, and cholesterol accumulation in the arterial wall is the predominant characteristic of atherosclerosis,” said lead study author Roksana Karim, PhD, MBBS, an associate professor of clinical preventive medicine at the Keck School of Medicine at the University of Southern California in Los Angeles. “Our results show that estradiol initiated earlier in menopause reduces atherosclerosis and appears to do so by directly reducing cholesterol accumulation in the arterial wall.”

Results were based on analysis of the Early versus Late Intervention Trial with Estradiol (ELITE). In that study, 643 healthy, postmenopausal women were divided into four groups, with participants in groups 1 and 2 randomized to 1 mg daily of estradiol or to a placebo pill within 6 years after the onset of menopause, while those in groups 3 and 4 were randomized to estradiol or to placebo more than a decade after menopause. Estradiol or placebo was used daily for an average of 5 years by all participants.

Study results were published in 2016 and suggested that women starting hormone therapy earlier in menopause experienced less progression of artery wall thickening, compared with those who started the hormone therapy later or who received the placebo.

Further investigation using lipid analysis revealed that the rate of atherosclerosis progression among early estradiol users was less than half in the arterial wall, compared to the women taking placebo who had gone through menopause within the last 6 years.

That was not the case for those who started the hormone therapy after 10 or more years, however.

“Our results show that starting estradiol soon after the onset of menopause may result in fewer cholesterol deposits in the arteries, compared to women starting estradiol much later,” Dr. Karim pointed out.

“The American Heart Association does not recommend hormone replacement therapy after the onset of menopause to prevent heart disease. Although some studies, like this one, show benefits, we are still seeing other trials with different outcomes. Because of that, estrogen replacement therapy should be used only to alleviate the symptoms of menopause,” explained Suzanne Steinbaum, DO, an American Heart Association volunteer expert, attending cardiologist and director of Women’s Heart Health of Northwell Lenox Hill Hospital, and senior faculty at Mount Sinai Hospital in New York City.

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