In the Journals

Hormone therapy affects heart fat in women during menopause

Samar El Khoudary

Epicardial adipose tissue accumulation may slow down in women who were recently menopausal and were taking oral conjugated equine estrogens, according to a secondary analysis of the KEEPS trial published in the Journal of the American Heart Association.

Women who were taking transdermal 17-estradiol had an increase in coronary artery calcium progression that was linked with paracardial adipose tissue accumulation, according to the study.

“Our findings showed for the first time that the use of hormone therapy affects the accumulation of heart fat, which is a new risk factor for cardiovascular disease that could be specific to midlife women or women who transition through menopause,” Samar El Khoudary, PhD, MPH, associate professor of epidemiology at University of Pittsburgh Graduate School of Public Health, told Cardiology Today.

Researchers analyzed data from 474 women (mean age, 53 years) from the KEEPS trial who were recently menopausal and were without CVD. Women were assigned to oral conjugated equine estrogens, transdermal 17-estradiol or placebo. Heart fat and CAC were measured at baseline and 48 months. The progression of CAC was defined as either an increase from 0 at baseline to greater than 0 at 48 months or an annualized change in CAC score of at least 10 for those with baseline CAC scores between 0 and 100.

Women assigned oral conjugated equine estrogens were less likely to have an increase in epicardial adipose tissue compared with those assigned placebo (OR = 0.62; 95% CI, 0.4-0.97). None of the groups had any changes in paracardial adipose tissue. There were no differences by treatment group for changes in epicardial and paracardial adipose tissue.

CAC progression was seen in 14% of women. The association between paracardial adipose tissue and CAC progression was modified by the assigned treatment (P = .02). Only in women assigned transdermal 17-estradiol was the association between paracardial adipose and CAC development significantly augmented.

“Cardiologists should recognize the acceleration in cardiovascular risk accompanied with the menopausal transition,” El Khoudary said in an interview. “It’s important to monitor women’s health during this critical stage. They should reinforce adopting heart-healthy lifestyles during menopause and after menopause.”

More research is needed to understand how hormone therapy affects different types of fat.

“We need research to help us understand what mechanism could explain why different formulas and ways of administration may impact different fat deposits in a different way,” El Khoudary told Cardiology Today. “With this research, we will be able to help clinicians to better individualize hormone therapy to achieve maximum benefit and minimize the risk.” – by Darlene Dobkowski

For more information:

Samar El Khoudary, PhD, MPH, can be reached at Epidemiology Data Center, University of Pittsburgh, 4420 Bayard St., Suite 600, Pittsburgh, PA 15260; email: elkhoudarys@edc.pitt.edu.

Disclosures: The KEEPS trial was sponsored by Abbott Pharmaceuticals, The Aurora Foundation, Bayer HealthCare and Pfizer Pharmaceuticals. El Khoudary reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Samar El Khoudary

Epicardial adipose tissue accumulation may slow down in women who were recently menopausal and were taking oral conjugated equine estrogens, according to a secondary analysis of the KEEPS trial published in the Journal of the American Heart Association.

Women who were taking transdermal 17-estradiol had an increase in coronary artery calcium progression that was linked with paracardial adipose tissue accumulation, according to the study.

“Our findings showed for the first time that the use of hormone therapy affects the accumulation of heart fat, which is a new risk factor for cardiovascular disease that could be specific to midlife women or women who transition through menopause,” Samar El Khoudary, PhD, MPH, associate professor of epidemiology at University of Pittsburgh Graduate School of Public Health, told Cardiology Today.

Researchers analyzed data from 474 women (mean age, 53 years) from the KEEPS trial who were recently menopausal and were without CVD. Women were assigned to oral conjugated equine estrogens, transdermal 17-estradiol or placebo. Heart fat and CAC were measured at baseline and 48 months. The progression of CAC was defined as either an increase from 0 at baseline to greater than 0 at 48 months or an annualized change in CAC score of at least 10 for those with baseline CAC scores between 0 and 100.

Women assigned oral conjugated equine estrogens were less likely to have an increase in epicardial adipose tissue compared with those assigned placebo (OR = 0.62; 95% CI, 0.4-0.97). None of the groups had any changes in paracardial adipose tissue. There were no differences by treatment group for changes in epicardial and paracardial adipose tissue.

CAC progression was seen in 14% of women. The association between paracardial adipose tissue and CAC progression was modified by the assigned treatment (P = .02). Only in women assigned transdermal 17-estradiol was the association between paracardial adipose and CAC development significantly augmented.

“Cardiologists should recognize the acceleration in cardiovascular risk accompanied with the menopausal transition,” El Khoudary said in an interview. “It’s important to monitor women’s health during this critical stage. They should reinforce adopting heart-healthy lifestyles during menopause and after menopause.”

More research is needed to understand how hormone therapy affects different types of fat.

“We need research to help us understand what mechanism could explain why different formulas and ways of administration may impact different fat deposits in a different way,” El Khoudary told Cardiology Today. “With this research, we will be able to help clinicians to better individualize hormone therapy to achieve maximum benefit and minimize the risk.” – by Darlene Dobkowski

For more information:

Samar El Khoudary, PhD, MPH, can be reached at Epidemiology Data Center, University of Pittsburgh, 4420 Bayard St., Suite 600, Pittsburgh, PA 15260; email: elkhoudarys@edc.pitt.edu.

Disclosures: The KEEPS trial was sponsored by Abbott Pharmaceuticals, The Aurora Foundation, Bayer HealthCare and Pfizer Pharmaceuticals. El Khoudary reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.