Date of Graduation

8-15-2009

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Anya Hill, PA-C

Second Advisor

Rob Rosenow PharmD, OD

Third Advisor

Annjanette Sommers MS, PA-C

Abstract

Background: Estrogen has, in the past, been widely recognized as an endogenous hormone that aids in the prevention of cardiovascular disease in postmenopausal women. However, conjugated equine estrogen with or without sequentially administered medroxyprogesterone, was demonstrated to provide no benefit in the prevention of cardiovascular disease and may in fact, aid in the progression of atherosclerotic disease in women on this type of hormone replacement therapy. More randomized controlled trials have been conducted recently to examine the effect of oral 17β-estradiol as opposed to conjugated equine estrogen, on the progression of atherosclerotic disease in postmenopausal women.

Objective: To determine whether oral 17β-estradiol with or without sequentially administered progestogen therapy has an effect on the progression and/or prevention of cardiovascular disease in postmenopausal women.

Study Design: Systematic review of the available medical literature.

Methods: An exhaustive systematic review of the medical literature was conducted using, MEDLINE, EBSCOhost, and EBMR Multifile using the keywords “estrogen replacement therapy” and “cardiovascular diseases.” Trials were only included in this review if published after 2001 and if the trial was randomized and controlled. Studies were rated using the Jadad criteria, and only studies with a Jadad score of 3 or higher were included in this review.

Results: Overall it was found that in three studies atherosclerotic risk was decreased in women on HRT, in three studies atherosclerotic risk was increased in women on HRT, and one study indicated no slowing in progression of atherosclerosis but decreased risk for cardiovascular disease by improving lipid profiles. It is important to note that all of the studies examined in this systematic review demonstrated a decrease in cardiovascular risk in patients taking HRT when the endpoint measured was a serum biochemical marker. The studies that demonstrated an increased risk for cardiovascular disease in women taking HRT measured endpoints including percent coronary or carotid artery stenosis.

Conclusion: Estrogen replacement therapy using 17β-estradiol appears to reduce multiple biochemical endpoints for cardiovascular disease risk including improving lipid profiles and decreasing inflammation. However, 17β-estradiol does not have a positive effect on the progression of atherosclerosis in the carotid or coronary arteries. Therefore, 17β-estradiol may reduce cardiovascular disease risk but evidence does not suggest that this improvement in lipid profiles and inflammation actually affects atherosclerosis progression.

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