Yale Bulletin and Calendar

April 13, 2007|Volume 35, Number 25

Study: Early estrogen therapy
may reduce cardiovascular risks

A new analysis of both estrogen and estrogen plus progestin data from the Women's Health Initiative (WHI) hormone trials in the Journal of the American Medical Association shows a 24% reduction in risk for coronary heart disease events in women who start hormone therapy less than 10 years after menopause.

The analysis, conducted by researchers at Yale and eight other study centers participating in the Kronos Early Estrogen Prevention Study (KEEPS), also showed a 30% reduction in overall deaths among women aged 50 to 59 using hormone therapy.

However, the new study, "Postmenopausal Hormone Therapy and Risk of Cardiovascular Disease by Age and Years Since Menopause," also found that hormone therapy increased coronary heart disease events by 28% in older women, and that deaths increased by 14% in women aged 70 to 79. There was a slightly elevated risk of stroke at all ages studied.

The WHI was stopped in July 2002 due to overall elevated risks. This new analysis indicates that excess cardiovascular risk is confined to older women, which is consistent with previous research, according to the researchers. Prior to the WHI, most data suggested that hormone therapy was associated with a high degree of protection (30% to 50% reductions) against coronary heart disease, all-cause mortality and osteoporotic fractures, in addition to a small increase in breast cancer risk, according to the scientists.

"This new analysis of WHI data seems to confirm earlier findings that estrogen may be good early, but bad late," says Dr. S. Mitchell Harman, director of the Kronos Longevity Research Institute. The institute is conducting the KEEPS, a randomized, controlled, double-blinded trial of 720 women designed to provide prospective data on the risks and benefits of early menopausal hormone therapy, particularly as it relates to the progression of atherosclerosis.

The lead investigator of the KEEPS trial at Yale is Dr. Hugh S. Taylor, associate professor in the Departments of Obstetrics, Gynecology and Reproductive Sciences, and Molecular Cellular and Developmental Biology.

"In this study," says Taylor, "hormone therapy reduced overall mortality in the younger menopausal women. It is important not to trivialize quality of life. No one should tell women to put up with hot flashes to avoid serious risk, if in reality this therapy saves lives."

The KEEPS trial will also examine whether the natural human estrogen, estradiol, delivered through the skin via a patch is equally effective as -- and potentially safer than -- oral estrogen. Researchers have speculated that this method may be safer since transdermal estrogen does not go to the liver in high concentrations and has been shown to have little or no effect on clotting disease.

"The WHI was instrumental in providing a roadmap for the next phase of research to examine whether estrogen protects younger women from cardiovascular disease, as earlier observational studies indicated, says Harman. "KEEPS is designed to provide useful new data to begin answering women's questions and help shape future research."

For more information on KEEPS, visit www.keepstudy.org or contact Diane Wall, clinical research nurse coordinator at (203) 785-4739 or diane.wall@yale.edu.

In addition to Yale, the KEEPS study centers include: Albert Einstein College of Medicine of Yeshiva University/Montefiore Medical Center, Bronx, New York; Columbia University College of Physicians and Surgeons, New York, New York; Harvard Medical School/Brigham and Women's Hospital, Boston, Massachusetts; Kronos Longevity Research Institute, Phoenix, Arizona; Mayo Clinic College of Medicine, Rochester, Minnesota; University of California-San Francisco/Center for Reproductive Health, San Francisco, California; University of Utah School of Medicine, Salt Lake City, Utah; and University of Washington School of Medicine, Seattle, Washington.

-- By Karen Peart

T H I SW E E K ' SS T O R I E S

Program celebrates town-gown ties, diversity

Charlie Rose of PBS to present Fryer Lecture

Study: Early estrogen therapy may reduce cardiovascular risks

In Focus: Women Faculty Forum

Exhibit celebrates centennial of Yale benefactor Paul Mellon

Three congregations to demonstrate ancient tradition of line-singing

Geologist Jun Korenaga is honored for his research on the Earth's mantle

Alumnus describes how life's challenges have also been a 'gift'

Vivian Perlis honored as chronicler of American music

Three award-winning alumni writers will read from their works

Yale Opera to stage classic operetta in a new style

Homage to director Rossellini will highlight program on Italian cinema

'Biodiversity and global change' are focus of Peabody event

Traditional calligraphy by Chinese student featured in benefit exhibition

Kristin Savard wins this year's Hockey Humanitarian Award

Campus Notes