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CV risks of oral HT vary according to estrogen type
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Risk for venous thrombosis and potential myocardial infarction may be higher with use of oral conjugated equine estrogens vs. oral estradiol, new data published in JAMA Internal Medicine suggest.
To gain insight into the cardiovascular risks associated with oral HT products, researchers evaluated 384 postmenopausal women aged 30 to 79 years who were using oral conjugated equine estrogens (CEEs) or oral estradiol in a population-based, case-control study. Venous thrombosis occurred in 68 participants, MI in 67 and ischemic stroke in 48. The other 201 participants were matched controls. All were current users of either form of HT.
Adjusted analyses linked current use of oral CEEs to a higher risk for venous thrombosis when compared with current oral estradiol use (OR=2.08; 95% CI, 1.02-4.27). Results also suggested an association between current CEEs use and an increased risk for MI, which was not statistically significant (OR=1.87; 95% CI, 0.91-3.84). However, the researchers found no connection between CEEs and risk for ischemic stroke (OR=1.13; 95% CI, 0.55-2.31).
Endogenous thrombin potential-based normalized activated protein C sensitivity ratios were also higher in participants using oral CEEs vs. oral estradiol, according to data from 140 control participants.
“We found in an observational study of HT use that women using oral CEEs were at an increased risk of incident [venous thrombosis] compared with women using oral estradiol. This finding was supported by biologic data on [activated protein C] resistance,” the researchers wrote.
“These results need replication but suggest that oral estrogen drugs have different levels of cardiovascular risk.”
Disclosure: See the full study for a list of researchers’ financial disclosures.
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