Hormone Therapy Formulation, Delivery May Affect Cardiovascular Benefits

By Anne Harding

February 15, 2020

NEW YORK (Reuters Health) - Menopausal hormone therapy (HT) may have different effects on atherosclerosis progression depending on formulation and route of administration, according to new findings from the KEEPS trial.

"The results suggest that compared to transdermal estrogen, the use of oral conjugated equine estrogen may slow down the adverse impact of pericardial fat on carotid intima-media thickness in recently menopausal women," Dr. Samar L. El Khoudary of the University of Pittsburgh, in Pennsylvania, told Reuters Health by phone.

But it's not clear whether the effects seen with oral conjugated equine estrogen (o-CEE) were related to administration route or formulation, the researcher added. "We need to stop using the word HT like a common word for all types of estrogen and all types of administration routes, because they are different," she said.

Dr. El Khoudary and her team looked at the progression of epicardial adipose tissue (EAT) and pericardial adipose tissue (PAT) in 467 women participating in the Kronos Early Estrogen Prevention Study (KEEPS), who had been randomized to 0.45 mg/day of o-CEE, 50 ug/day transdermal 17beta-estradiol (t-E2), or placebo for 48 months.

Neither EAT or PAT changes were associated with progression in CIMT, but the association between PAT and carotid intima-media thickness (CIMT) varied by treatment group, they report in Menopause. For each one standard deviation increase in PAT, adjusted CIMT progression was 12.66 um less in the o-CEE group compared to the t-E2 group (P=0.02), and 10.09 um less with o-CEE compared to placebo (P=0.03).

"Consistent with previous work from the Study of Women's Health Across the Nation (SWAN), our findings suggest a stronger contribution of estrogen to the pathophysiological consequences of PAT depot than EAT depot in midlife women," Dr. El Khoudary and her colleagues write.

"We are seeing in this study that different estrogen formulations and routes of administration do have different effects in the body. This will help us work toward truly individualizing hormone therapy based a woman's history, risk factors and preferences," Dr. Stephanie S. Faubion, the medical director of The North American Menopause Society and director of the Mayo Clinic Center for Women's Health in Rochester, Minnesota, told Reuters Health by email.

But no changes in practice should be made based on the study, she added.

"And the message isn't that one type of hormone therapy is bad and another is good. It's really about looking at the differences and using those differences to best meet the needs of women," said Dr. Faubion, who was not involved in the study.

KEEPS did not have commercial funding, but the medications were supplied in part by the manufacturers.

SOURCE: https://bit.ly/37nVhPs Menopause, online February 3, 2020.