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Postmenopausal Estrogen Use and Coronary Atherosclerosis

JAY M. SULLIVAN, M.D.; ROGER VANDER ZWAAG, Ph.D.; GEORGE F. LEMP, D.P.H.; JEFF P. HUGHES, M.A.; VIRGINIA MADDOCK, B.S.; FRANK W. KROETZ, M.D.; K. B. RAMANATHAN, M.D.; and DAVID M. MIRVIS, M.D.
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▸Requests for reprints should be addressed to Jay M. Sullivan, M.D.; University of Tennessee, Memphis, 951 Court, Room 353D; Memphis, TN 38163.


Memphis, Tennessee


© 1988 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1988;108(3):358-363. doi:10.7326/0003-4819-108-3-358
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Study Objective: To determine whether estrogen replacement therapy affects the prevalence of severely obstructive coronary arterial lesions defined by selective coronary arteriography.

Design: Case-control study.

Setting: Large, urban, university-affiliated referral hospital.

Patients: From a consecutive sample of 6452 women having coronary arteriography between 1972 and 1984, 2188 patients were eligible for study; others were excluded because they were nonmenopausal, had congenital heart defects, valvular heart disorders, primary myocardial disease, or no more than mild to moderate coronary artery disease.

Interventions: None.

Measurements and Main Results: Hospital nurses routinely obtained medication histories. Staff invasive cardiologists interpreted coronary arteriograms. Clinical, laboratory, and angiographic data were abstracted from the cardiac catheterization reports and entered into a computerized registry. Postmenopausal estrogen use for 1444 cases of coronary artery disease (70% stenosis) was compared to that of 744 controls (0% stenosis). The odds ratio estimate of the risk of coronary artery disease for estrogen users relative to the risk of coronary artery disease for nonusers was 0.44 (95% confidence interval, 0.29 to 0.67) after adjustment for age, cigarette smoking, diabetes, cholesterol, and hypertension. Postmenopausal estrogen replacement was a significant independent protective factor for coronary artery disease in a multivariate logistic regression model (P = 0.037).

Conclusions: The data suggest that postmenopausal estrogen treatment reduces the risk for angiographically significant coronary artery disease.

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