Longer lifetime menses, hormone replacement therapy linked to improvements in PH

Key takeaways:

• Researchers assessed how hormone exposures impact right ventricular function and pulmonary vascular disease in PH.
• Findings among those with Group 1 PH were relatively similar to those for all PH groups.

SAN DIEGO — Measures of pulmonary vascular disease and right ventricular function improved with longer lifetime menses in pulmonary hypertension, according to research presented at the American Thoracic Society International Conference.

Hormone replacement therapy use among women with PH was also linked to better pulmonary vascular disease and right ventricular function, according to researchers.

Audriana Hurbon

“We know that in Group 1 pulmonary hypertension, women can be affected more often than men, [but] ... once affected, we have observed less severe disease than men,” Audriana Hurbon, MD, assistant clinical professor of medicine at The University of Arizona’s College of Medicine Tucson, told Healio. “We wanted to explore a suspected hormonal contribution to this observation.”

Using individuals from the Pulmonary Vascular Disease Phenomics (PVDOMICS) study, Hurbon and colleagues assessed 742 self-reported women who either had pulmonary hypertension (groups 1-5), had risk factors for PH without the disease (comparators) or were classified as healthy controls to find out how self-reported length of menses (endogenous hormone exposure) and hormone replacement therapy (exogenous hormone exposure) each impact right ventricular (RV) function and pulmonary vascular disease.

Researchers used echocardiography to capture two measures of RV function (RV fractional shortening and RV ejection fraction), whereas mean pulmonary arterial pressure on right heart catheterization was used to find pulmonary vascular resistance, which represents pulmonary vascular disease.

Patients with PH and more than 50 years of menses had a significantly lower mean pulmonary arterial pressure than patients with 20 to 30 years of menses (37 mmHg vs. 47 mmHg; P = .008) when considering all PH groups.

Shifting focus to only patients with Group 1 PH revealed again that those with more years of menses had reduced mean pulmonary arterial pressure (> 40 years of menses, 41 mmHg vs. 30 to 39 years of menses, 50 mmHg; P < .01), according to researchers.

Additionally, those with more than 40 years of menses in this subgroup had greater RV fractional shortening than those with 30 to 39 years (34% vs. 29%; P = .05).

When evaluating the impact of hormone replacement therapy among all PH groups, researchers found four significant improvements in RV function and pulmonary vascular disease with use vs. no use of this therapy:

• higher RV fractional shortening (37 vs. 32; P = .001);
• higher RV ejection fraction (48% vs. 40%; P < .0001);
• lower mean pulmonary pressure (35 mmHg vs. 42 mmHg; P = .002); and
• lower pulmonary vascular resistance (5 vs. 7; P = .006).

“So far, our preliminary data has been positive with improvement with mean pulmonary arterial pressure, pulmonary vascular resistance, RV ejection fraction and RV fractional shortening with the use of hormone replacement therapy in the PH cohort,” Hurbon told Healio.

In the subgroup analysis of patients with Group 1 PH, researchers observed three of the four significant differences highlighted above between those who did vs. did not use hormone replacement therapy, including higher RV ejection fraction (46% vs. 38%; P = .003), lower mean pulmonary arterial pressure (37 mmHg vs. 44 mmHg; P = .008) and lower pulmonary vascular resistance (6 vs. 7; P = .04).

“We didn't observe a difference with the healthy controls or comparator with increased lifetime duration of menses or with use of hormone replacement therapy,” Hurbon said. “These findings were consistent with our hypothesis that suggests that hormones could be protective with this pulmonary hypertension subgroup.”

Lastly, researchers did not find statistical differences when analyzing PH Groups 2 through 5.

“Further research will explore impact of specific types of hormone replacement therapy as well as duration of use,” Hurbon said.

References:

• Hormone replacement therapy (HRT) may improve pulmonary hypertension and right ventricular function. https://site.thoracic.org/about-us/news/2024-international-conference-press-release/hormone-replacement-therapy-hrt-may-improve-pulmonary-hypertension-and-right-ventricular-function. Published May 19, 2024. Accessed May 19, 2024.
• Hurbon A, et al. Am J Respir Crit Care Med. 2024;doi:10.1154/ajrccm-conference.2024.209.1_MeetingAbstracts.A2748.