menopause

CAC May Progress During Menopause With Certain Hormone Therapy

Hormone therapy formulations have different impacts on epicardial and paracardial adipose tissue in women who have recently entered menopause, according to a new analysis. In fact, the researchers determined that while transdermal 17β‐estradiol may increase the progression of coronary artery calcification (CAC) associated with paracardial adipose tissue accumulation, oral conjugated equine estrogens may slow epicardial adipose tissue accumulation.

To measure the ways in which exogenous estrogen preparations affect epicardial and paracardial adipose tissue, as well as how different hormone therapy formulations alter the progression of CAC, the researchers studied the results of the Kronos Early Estrogen Prevention Study (KEEPS).

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In all, 727 women aged 42 to 58 years who were in the early stages of menopause were included in KEEPS. These participants were randomly assigned to take either oral conjugated equine estrogens, 0.45 mg/d; transdermal 17β‐estradiol, 50 µg/d; or placebo and were followed for 48 months. 

The researchers then calculated the progression of subclinical atherosclerosis over 48 months among each group. CAC progression was present if:

  • The CAC score changed from 0 at baseline to more than 0 at month 48 or
  • The CAC score was between 0 and 100 at baseline then changed by 10 or more a year.

Of the 727 participants, 474 had computed-tomography–based heart fat and CAC measures collected both at baseline and month 48.

Results showed that participants who were taking oral conjugated equine estrogens were less likely to have any increase in epicardial adipose tissue than participants taking placebo.

According to the researchers, no group experienced a change in paracardial adipose tissue. Further, changes in epicardial and paracardial adipose tissue did not differ by treatment group.

However, the association between paracardial adipose tissue and CAC did change depending on the assigned treatment. While 14% of all participants had an increase in CAC, only those taking transdermal 17β‐estradiol experienced paracardial adipose tissue increases that were associated with CAC increases.

“[Hormone therapy] remains the best therapeutic option for the relief of debilitating menopausal symptoms,” the researchers concluded. “Clinicians should continue to individualize [hormone therapy] prescription using best available evidence to maximize benefits and minimize risks.”

—Colleen Murphy

Reference:

El Khoudary SR, Zhao Q, Venugopal V, et al. Effects of hormone therapy on heart fat and coronary artery calcification progression: secondary analysis from the KEEPS trial. J Am Heart Assoc. 2019;8(15). doi:10.1161/JAHA.119.012763.