YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==ESTROGEN REPLACEMENT THERAPY== 11 AUTHOR Lobo RA TITLE Cardiovascular implications of estrogen replacement therapy. SOURCE Obstet Gynecol; VOL 75, ISS 4 Suppl, 1990, P18S-25S; discussion 31S-35S (REF: 43) ABSTRACT Estrogen appears to protect against the development of cardiovascular disease, the leading cause of death in women, by a number of mechanisms. The protective effect is believed to be mediated principally by beneficial changes in cholesterol levels. Estrogen decreases low-density lipoprotein (LDL) cholesterol and increases high-density lipoprotein (HDL) cholesterol levels by mechanisms that include the possible induction of LDL receptors and the destruction of hepatic lipase, which degrades HDL cholesterol. However, estrogen also appears to have a direct beneficial effect on vessel-wall physiology. One of these effects may be an increase in local prostacyclin production. The type of estrogen used in hormone replacement therapy and the route of administration determine the positive and negative effects of estrogen on the cardiovascular system. In general, synthetic estrogens, because they are manyfold more potent than natural estrogens, should not be used. Most studies show a 50% or greater reduction in cardiovascular disease and related mortality with postmenopausal estrogen administration. There is no evidence that postmenopausal estrogen replacement adversely affects carbohydrate metabolism, blood pressure, or coagulation. By use of a mathematical model to study the overall effects of estrogen therapy, it can be shown that more lives can be saved from the reduction in cardiovascular disease with estrogen use than from the reduction in death from osteoporosis or any other disease state affected by estrogen. Serious consideration has to be given to the cardiovascular effects of added progestogen, which may attenuate or eliminate the beneficial effects of estrogen on HDL2 cholesterol.(ABSTRACT TRUNCATED AT 250 WORDS) 12 AUTHOR Notelovitz M TITLE Estrogen replacement therapy: indications, contraindications, and agent selection [see comments] SOURCE Am J Obstet Gynecol; VOL 161, ISS 6 Pt 2, 1989, P1832-41 (REF: 107) ABSTRACT Three groups of indications exist for postmenopausal estrogen use: relief of symptoms related to estrogen deficiency, osteoporosis prophylaxis and treatment, and cardioprotection. Estrogen replacement therapy enhances a woman's sense of well-being and reduces the morbidity, mortality, and health care costs associated with osteoporosis and atherosclerotic heart disease. There are a few absolute contraindications to estrogen replacement therapy. Many estrogen preparations are currently available in the United States. Establishing equivalencies among the different preparations is complicated by the many physiologic and pharmacologic effects of estrogens and the variety of treatment end points used. Most estrogens have the same biologic effect provided equivalent blood levels are achieved. Estrogen replacement therapy has proved beneficial to selected postmenopausal women. 11 AUTHOR Barret-Connor E AUTHOR Wingard DL AUTHOR Criqui MH TITLE Postmenopausal estrogen use and heart disease risk factors in the 1980s: Rancho Bernardo, California, revisited SOURCE JAMA; VOL 261 ISS Apr 14 1989, P2095-2100, (REF 16) ABSTRACT IPA COPYRIGHT: ASHP A study of risk factors for heart disease associated with the use of estrogens, either alone or in combination with progestins, was conducted among 1057 postmenopausal women, aged 50-79 yr, all of whom had been treated with estrogens alone or with progestins; of these, 240 had been treated with conjugated estrogens (Premarin; I), and 69 of these had also received medroxyprogesterone acetate (Provera; II). A survey of estrogen use had been conducted in the community 12 yr before the present study. Overall, current users did not have a more favorable cardiac risk profile before use. Similar to earlier findings, estrogen use was associated with lower weight, diastolic blood pressure, and fasting plasma glucose level than nonuse. Levels of low-density lipoprotein (LDL) cholesterol were positively related to estrogen dose; levels of high-density lipoprotein (HDL) cholesterol were positively related to duration of use. After adjusting for covariates in patients specifically given I alone or with II, those given I alone had significantly more favorable HDL and LDL cholesterol and fasting plasma glucose levels, but had higher triglyceride levels than non-users. Results were similar in women taking I plus II. Women who received the I plus II regimen also had significantly lower blood pressure than women who used no estrogen. There were no differences in risk factor levels between patients given I alone and those given I and II. 12 AUTHOR Petitti DB AUTHOR Perlman JA AUTHOR Sidney S TITLE Postmenopausal estrogen use and heart disease SOURCE N. Engl. J. Med.; VOL 315 ISS Jul 10 1986, P131-132, (REF 17) ABSTRACT IPA COPYRIGHT: ASHP The findings and follow up of the Walnut Creek Contraceptive Drug Study on the relation of postmenopausal estrogen use and cardiovascular diseases in 16,638 women who were between the ages of 18 and 54 when recruited to the study in the late 1960's and early 1970's are reported. The relative risk of death from cardiovascular disease was 0.8 in women with any postmenopausal estrogen use. The relative risk of hospitalization for cardiovascular disease in women with any postmenopausal estrogen use was 0.9. After adjustment, the relative risk of death from cardiovascular disease was 0.5 in women with postmenopausal estrogen use. The relative risk of hospitalization for cardiovascular disease after adjustment for other risk factors was one. The relative risk of death from accidents, homicides and suicide was also substantially lower in postmenopausal estrogen users than in women who never used sex steroid hormones. The results are best explained by the assumption that postmenopausal estrogen users in this cohort are healthier than those who had no postmenopausal estrogen use, in ways that have not been quantified and cannot be adjusted for.