1
|
Kirichenko TV, Myasoedova VA, Ravani AL, Sobenin IA, Orekhova VA, Romanenko EB, Poggio P, Wu WK, Orekhov AN. Carotid Atherosclerosis Progression in Postmenopausal Women Receiving a Mixed Phytoestrogen Regimen: Plausible Parallels with Kronos Early Estrogen Replacement Study. BIOLOGY 2020; 9:biology9030048. [PMID: 32155747 PMCID: PMC7150954 DOI: 10.3390/biology9030048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 01/28/2023]
Abstract
This randomized double-blinded, placebo-controlled clinical trial evaluated the progression of intima-media thickness of common carotid artery (cIMT) and the effect of phytoestrogen therapy on atherosclerosis development in early and late postmenopausal women. The 2-year cIMT progression was evaluated in 315 early postmenopausal women aged 40-55 years and in 231 late postmenopausal women aged 60-69 years free of cardiovascular disease. B-mode ultrasound was done at baseline and after 12 and 24 months of follow-up. The study revealed no significant changes in the rate of cIMT progression in 315 early postmenopausal women. By contrast, a statistically significant difference in the rate of atherosclerosis development was observed in late postmenopausal women treated with phytoestrogens compared to placebo (p = 0.008). The rate of cIMT progression in the placebo group was 0.019 mm/year led to a significant increase of cIMT during the observation period (p = 0.012), while the rate of cIMT progression in phytoestrogen late postmenopausal recipients was 0.011 mm/year, and total change did not reach statistical significance during the follow-up period (p = 0.101). These results suggest that late postmenopausal women can be a suitable cohort for trials assessing the anti-atherosclerosis effects of phytoestrogen preparations. In particular, the beneficial effect of phytoestrogens on cIMT progression was demonstrated in late postmenopausal women.
Collapse
Affiliation(s)
- Tatiana V. Kirichenko
- Research Institute of Human Morphology, 3 Tsyurupy Str., 117418 Moscow, Russia; (I.A.S.); (A.N.O.)
- National Medical Research Center of Cardiology, 15A 3 Cherepkovskaya Str., 121552 Moscow, Russia
- Institute of General Pathology and Pathophysiology, 8 Baltiyskaya Str., 125315 Moscow, Russia; (V.A.M.); (V.A.O.)
- Correspondence: ; Tel.: +7-910-461-58-45
| | - Veronika A. Myasoedova
- Institute of General Pathology and Pathophysiology, 8 Baltiyskaya Str., 125315 Moscow, Russia; (V.A.M.); (V.A.O.)
- Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy; (A.L.R.); (P.P.)
| | - Alessio L. Ravani
- Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy; (A.L.R.); (P.P.)
| | - Igor A. Sobenin
- Research Institute of Human Morphology, 3 Tsyurupy Str., 117418 Moscow, Russia; (I.A.S.); (A.N.O.)
- National Medical Research Center of Cardiology, 15A 3 Cherepkovskaya Str., 121552 Moscow, Russia
- Institute of General Pathology and Pathophysiology, 8 Baltiyskaya Str., 125315 Moscow, Russia; (V.A.M.); (V.A.O.)
| | - Varvara A. Orekhova
- Institute of General Pathology and Pathophysiology, 8 Baltiyskaya Str., 125315 Moscow, Russia; (V.A.M.); (V.A.O.)
- Institute for Atherosclerosis Research, Skolkovo Innovative Center, 143025 Moscow, Russia
| | - Elena B. Romanenko
- Department of Molecular Basis of Ontogenesis, Belozersky Institute of Physical and Chemical Biology, Moscow State University, 119234 Moscow, Russia;
| | - Paolo Poggio
- Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy; (A.L.R.); (P.P.)
| | - Wei-Kai Wu
- Department of Internal Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei 108, Taiwan;
| | - Alexander N. Orekhov
- Research Institute of Human Morphology, 3 Tsyurupy Str., 117418 Moscow, Russia; (I.A.S.); (A.N.O.)
- Institute of General Pathology and Pathophysiology, 8 Baltiyskaya Str., 125315 Moscow, Russia; (V.A.M.); (V.A.O.)
- Institute for Atherosclerosis Research, Skolkovo Innovative Center, 143025 Moscow, Russia
| |
Collapse
|
2
|
Wang X, Lu L, Tan Y, Jiang L, Zhao M, Gao E, Yu S, Liu J. GPR 30 reduces myocardial infarct area and fibrosis in female ovariectomized mice by activating the PI3K/AKT pathway. Life Sci 2019; 226:22-32. [PMID: 30905784 DOI: 10.1016/j.lfs.2019.03.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 12/30/2022]
Abstract
AIMS Estrogen plays an important role in cardioprotection. Animal experiments showed that the G-protein coupled estrogen receptor 30 (GPR30) specific agonist G1 could reduce post-ischemic dysfunction and inhibit cardiac fibroblast proliferation. However, the underlying mechanism of action is not clear. The current study tests the hypothesis that GPR30 reduces myocardial infarct area and fibrosis in female ovariectomized (OVX) mice by activating the PI3K/AKT pathway. MAIN METHODS In this study, we established a myocardial infarction (MI) animal model derived from OVX C57BL/6 female mice, and investigated the effect of G1 on cardiac function by echocardiography and Hemodynamics, morphology and expression of fibrosis-related and apoptosis-related proteins by Masson's trichrome and H&E, Immunofluorescence, Western blotting and TUNEL. KEY FINDINGS Combination with OVX significantly increased myocardial fibrosis and MI area compared to MI treatment alone, as determined by echocardiography and hemodynamics. Further addition of G1 changed the expression of apoptosis-related proteins, decreased the levels of tumor necrosis factor-α and interleukin-10, and reduced the degree of myocardial fibrosis and myocardial infarct area. Primary cultured cardiac fibroblasts (CFs) were subjected to hypoxia/serum deprivation (H/SD) simulating the in vivo ischemia model. When the PI3K/AKT pathway was inhibited by wortmanin in H/SD CFs, G1 failed to induce significant changes in the expression of apoptosis-related proteins. SIGNIFICANCE It suggested that GPR30 may improve cardiac function in female OVX mice by activating the PI3K/AKT pathway and reducing myocardial infarct size and fibrosis.
Collapse
Affiliation(s)
- Xiaowu Wang
- Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, PR China
| | - Linhe Lu
- Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, PR China
| | - Yanzhen Tan
- Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, PR China
| | - Liqing Jiang
- Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, PR China
| | - Minggao Zhao
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an 710032, PR China
| | - Erhe Gao
- Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
| | - Shiqiang Yu
- Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, PR China
| | - Jincheng Liu
- Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, PR China.
| |
Collapse
|
3
|
Kim JE, Choi J, Park J, Lee JK, Shin A, Park SM, Kang D, Choi JY. Associations of postmenopausal hormone therapy with metabolic syndrome among diabetic and non-diabetic women. Maturitas 2019; 121:76-82. [DOI: 10.1016/j.maturitas.2018.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/10/2018] [Accepted: 12/19/2018] [Indexed: 11/15/2022]
|
4
|
Changes in cardiovascular function based on adrenalin and norepinephrine metabolism in ovariectomized rats. Exp Gerontol 2017; 91:15-24. [DOI: 10.1016/j.exger.2017.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/19/2017] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
|
5
|
Vitale C, Mammi C, Gambacciani M, Russo N, Spoletini I, Fini M, Volterrani M, Rosano GMC. Effect of hormone replacement therapy with the anti-mineralocorticoid progestin Drospirenone compared to tibolone on endothelial function and central haemodynamics in post-menopausal women. Int J Cardiol 2016; 227:217-221. [PMID: 27843051 DOI: 10.1016/j.ijcard.2016.11.149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/06/2016] [Indexed: 01/28/2023]
Abstract
Drospirenone (DRSP) is an antialdosterone agent with progestogenic and antiandrogenic effects. This compound, has been recently used in combination with 17β-estradiol (E2) as hormonal therapy in postmenopausal women and has been shown to exert a significant antihypertensive effect in hypertensive post-menopausal women. Aim of the present study was to compare the effect of DRSP/E2 with those of Tibolone (T) on endothelial function, arterial stiffness, and lipid profile of early postmenopausal women naïve on post-menopausal hormonal therapy. Twenty-four women met the inclusion criteria and entered the study. Women were randomized to receive either DRSP/E2 or T for 6months. Blood pressure and heart rate were similar in both groups at baseline and at the end of the study. Compared to baseline, endothelial function assessed by Reactive Hyperemia (RH) significantly improved in women receiving E2/DRSP, whereas no significant differences between baseline and follow up were detected in women receiving Tibolone. Women receiving E2/DRSP showed a significant decrease in pulse wave velocity and Augmentation Index compared to baseline while no changes were observed in women receiving Tibolone. The capacity of sera to trigger endothelial cells apoptosis in vitro measured by cell death assay was significantly reduced by E/DRSP but not by T (HFA-E 70±5,6% vs HFD-E 41±4,5%, p<0,001). In conclusion, the present study shows that the association of Estradiol and Drospirenone as hormonal replacement therapy significantly improves vascular parameters and the composition of sera relevant for vascular protection in early post-menopausal normotensive women. These effects are not shared by Tibolone.
Collapse
Affiliation(s)
- Cristiana Vitale
- Department of Medical Sciences, IRCCS San Raffaele, Roma, Italy.
| | - Caterina Mammi
- Department of Medical Sciences, IRCCS San Raffaele, Roma, Italy
| | | | - Novella Russo
- Department of Medical Sciences, IRCCS San Raffaele, Roma, Italy
| | | | - Massimo Fini
- Department of Medical Sciences, IRCCS San Raffaele, Roma, Italy
| | | | - Giuseppe M C Rosano
- Department of Medical Sciences, IRCCS San Raffaele, Roma, Italy; Cardiovascular & Cell Sciences Institute, St Georges Hospital Medical School, London, UK
| |
Collapse
|
6
|
Laffin LJ, Majewski C, Liao C, Bakris GL. Relationship Between Obesity, Hypertension, and Aldosterone Production in Postmenopausal African American Women: A Pilot Study. J Clin Hypertens (Greenwich) 2016; 18:1216-1221. [DOI: 10.1111/jch.12857] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/25/2016] [Accepted: 04/29/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Luke J. Laffin
- Department of Medicine; ASH Comprehensive Hypertension Center; Section of Endocrinology, Diabetes and Metabolism; The University of Chicago Medicine; Chicago IL USA
| | - Colleen Majewski
- Department of Medicine; ASH Comprehensive Hypertension Center; Section of Endocrinology, Diabetes and Metabolism; The University of Chicago Medicine; Chicago IL USA
| | - Chuanhong Liao
- Department of Public Health Studies; The University of Chicago Biological Sciences; Chicago IL USA
| | - George L. Bakris
- Department of Medicine; ASH Comprehensive Hypertension Center; Section of Endocrinology, Diabetes and Metabolism; The University of Chicago Medicine; Chicago IL USA
| |
Collapse
|
7
|
Ki EY, Hur SY, Park JS, Do Han K, Park YG. Differences in the lipid profile and hormone replacement therapy use in Korean postmenopausal women: the Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012. Arch Gynecol Obstet 2015; 294:165-73. [PMID: 26688284 PMCID: PMC4908158 DOI: 10.1007/s00404-015-3982-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/03/2015] [Indexed: 01/17/2023]
Abstract
Purpose Hormonal changes after menopause can cause dyslipidemia by the cessation of endogenous estrogen. We analyzed the lipid profile of the Korean healthy menopausal women according to the use of hormone replacement therapy (HRT). Methods Data obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) 2010–2012 were analyzed. The study included 428 healthy postmenopausal women with HRT (HRT group) and 1804 healthy postmenopausal women without HRT (NHRT group). Results After adjustment for confounding factors, total cholesterol (TC) and low-density lipoprotein (LDL) were lower in the HRT group than in the NHRT group (TC: 200.1 ± 2.0 vs. 204.9 ± 1.1, P = 0.04; LDL: 120.3 ± 1.0 vs. 124.5 ± 1.0 mg/ml, P = 0.033). Triglycerides (TG) were lower in the HRT group than in the NHRT group [106.8, (95 % CI 99.8–114.3) vs. 115.1 (95 % CI 111.8–118.5), P = 0.04]. Non-high-density lipoprotein (HDL) was lower in the HRT group than in the NHRT group (145.4 ± 1.9 vs. 151.2 ± 1.0 mg/ml, P = 0.008). Patients with HRT were lower in the LDL cholesterol level (OR 0.601, 95 % CI 0.397–0.917, P = 0.018), the total cholesterol to high-density lipoprotein ratio (OR 0.787, 95 % CI 0.617–0.997, P = 0.016), and the non-HDL level (OR 0.68, 95 % CI 0.509–0.907, P = 0.009). Conclusion The results of this study suggest that the use of HRT may have a positive effect on dyslipidemia in postmenopausal women.
Collapse
Affiliation(s)
- Eun Young Ki
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Young Hur
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Sup Park
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Do Han
- Department of Medical Life Science, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea
| | - Yong Gyu Park
- Department of Medical Life Science, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea.
| |
Collapse
|
8
|
The ocular benefits of estrogen replacement therapy: a population-based study in postmenopausal Korean women. PLoS One 2014; 9:e106473. [PMID: 25210892 PMCID: PMC4161336 DOI: 10.1371/journal.pone.0106473] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 08/07/2014] [Indexed: 02/01/2023] Open
Abstract
Purpose To elucidate the prevalence of cataract, glaucoma, pterygia, and diabetic retinopathy among Korean postmenopausal women with or without estrogen replacement therapy (ERT). Methods A cross-sectional, nationally representative sample from the 4th Korea National Health and Nutrition Examination Survey (KNHANES IV) (2007–2009) was used. Participants were interviewed for the determination of socioeconomic and gynecologic factors. Each woman also underwent an ophthalmologic examination and provided a blood sample for risk factor assessment. Results Of 3968 postmenopausal women enrolled, 3390 had never received estrogen, and 578 were undergoing estrogen treatment. After adjusting for age, diabetes, hypertension, high cholesterol levels, and high low-density lipoprotein levels, the prevalence of anterior polar cataract, retinal nerve fiber layer (RNFL) defect, and flesh pterygium was higher in the non-ERT group (OR, 3.24; 95% CI, 1.12–9.35, OR 1.70; 95% CI, 1.04–2.78, OR 3.725; 95% CI, 1.21–11.45, respectively). Further, the prevalence of atrophic pterygium was lower in the non-ERT group compared to that in the ERT group (OR, 0.21, 95% CI, 0.07–0.63). Conclusions These data suggest that ERT has a protective effect against the development of anterior polar cataract, flesh pterygium, and RNFL defect.
Collapse
|
9
|
Lunenfeld B, Stratton P. The clinical consequences of an ageing world and preventive strategies. Best Pract Res Clin Obstet Gynaecol 2013; 27:643-59. [PMID: 23541823 PMCID: PMC3776003 DOI: 10.1016/j.bpobgyn.2013.02.005] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 02/10/2013] [Indexed: 12/21/2022]
Abstract
Over the past century, the world has seen unprecedented declines in mortality rates, leading to an accelerated increase in the world population. This century will realise falling fertility rates alongside ageing populations. The 20th century was the century of population growth; the 21st century will be remembered as the century of ageing. Increase in life expectancy is one of the highest achievements of humankind; however, ageing and age-related disease is a mounting challenge for individuals, families, and for social, economic, and healthcare systems. Since healthy life expectancy has lagged behind the increase in life expectancy, the rise in morbidity will increase the burden on healthcare systems. Implementation of preventive health strategies to decrease, delay or prevent frailty, lung, breast and colon cancer, cardiovascular disease, metabolic syndrome, osteoporosis and osteopaenia, may increase health expectancy, and permit women to age gracefully and maintain independent living, without disability, for as long as possible.
Collapse
Affiliation(s)
- Bruno Lunenfeld
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan 52900, Israel.
| | | |
Collapse
|
10
|
Testosterone promotes vascular endothelial cell migration via upregulation of ROCK-2/moesin cascade. Mol Biol Rep 2013; 40:6729-35. [PMID: 24065547 DOI: 10.1007/s11033-013-2788-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 09/14/2013] [Indexed: 01/20/2023]
Abstract
Cross-sectional studies have demonstrated a reverse relationship between serum level of testosterone (T) and the incidence rate of cardiovascular disease in men, indicating that T exerts beneficial effects in cardiovascular system. However, the endothelial effects of T are poorly understood. Actin remodeling is essential for endothelial cell movement and vascular repair and this process is controlled by the actin-binding protein moesin. In the present study, we studied the effects of T on actin remodeling, moesin expression and phosphorylation, as well as cell migration in cultured human umbilical endothelial cells (hUVECs). We found that T provoked the formation of cortical actin complexes and membrane protrusions in endothelial cells. Treatment with T induced dose- and time-dependent increase of moesin expression and phosphorylation, which was inhibited by the addition of androgen receptor antagonist hydroxyflutamide (HF). Moreover, T enhanced ROCK-2 activity. The ROCK-2 inhibitor Y27632 or the transfection of ROCK-2 siRNA largely inhibited T-induced moesin expression and phosphorylation, indicating that ROCK-2 pathway is crucial for these effects. T promoted endothelial cell migration, which was inhibited by the addition of HF or Y27632. In conclusion, T induces actin cytoskeleton remodeling by regulating moesin expression and activation, resulting in enhanced endothelial cell migration. Our work adds new insights into endothelial mechanisms of T, which is relevant for its vascular actions.
Collapse
|
11
|
Mahendru AA, Morris E. Cardiovascular disease in menopause: Does the obstetric history have any bearing? ACTA ACUST UNITED AC 2013; 19:115-20. [DOI: 10.1177/1754045313495675] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiovascular disease remains a leading cause of morbidity and mortality in menopausal women in spite of the overall reduction in age-adjusted mortality from the disease in the last few years. It is now clear that mechanisms of cardiovascular disease in menopausal women are similar to men and rather than midlife acceleration of cardiovascular disease in women, the final impact of cardiovascular disease in later life may be a reflection of cardiovascular changes during reproductive years as a result of woman’s obstetric history. A decade after the Women’s Health Initiative trial, there is upcoming evidence to suggest that hormone replacement therapy in young recently menopausal women has a cardioprotective effect. Cardiovascular changes during normal pregnancy or pregnancy complications such as preeclampsia may affect a woman’s long-term cardiovascular health. Therefore, it is plausible that the cardioprotective benefit of hormone replacement therapy depends on occult pre-existing cardiovascular risks in women in relation to their previous obstetric history. In this review, we describe the cardiovascular changes during and after pregnancy in obstetric complications such as recurrent miscarriage, preeclampsia, intrauterine growth restriction, preterm labour and gestational diabetes; existing evidence regarding their association with cardiovascular disease later in life, and hypothesize possible mechanisms. Our aim is to improve the understanding and highlight the importance of including obstetric history in risk assessment in menopausal women and individualizing their risks before prescribing hormone replacement therapy. Future research in risk benefit assessment of hormone replacement therapy should also account for a woman’s background cardiovascular risk in the light of her obstetric history.
Collapse
Affiliation(s)
- Amita A Mahendru
- Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Edward Morris
- Norfolk and Norwich University Hospital, Norwich, UK
| |
Collapse
|
12
|
Mirkin S, Komm BS, Pickar JH. Conjugated estrogens for the treatment of menopausal symptoms: a review of safety data. Expert Opin Drug Saf 2013; 13:45-56. [PMID: 23919270 DOI: 10.1517/14740338.2013.824965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Conjugated equine estrogens (CEE) are widely used for the treatment of menopausal symptoms, such as vasomotor symptoms and vulvovaginal atrophy, and for the prevention of bone loss, in postmenopausal women. The safety profile of CEE has been extensively published over the past 20 years. AREAS COVERED Data from randomized controlled trials and from observational studies on the effects of CEE on the risk of breast cancer, endometrial cancer or hyperplasia, other cancers, cardiovascular outcomes, and cognitive function are reviewed. When used alone, CEE are not associated with an increased risk of breast cancer and may be associated with reduced mortality. The risk of cardiovascular events with CEE may be reduced in women who are more recently postmenopausal. EXPERT OPINION Numerous clinical studies have evaluated the safety of CEE. The data reviewed in this article describe the breast, endometrial, and cardiovascular safety of unopposed CEE. International recommendations describe CEE as the menopausal symptom treatment of choice, particularly in young or recently postmenopausal hysterectomized women.
Collapse
Affiliation(s)
- Sebastian Mirkin
- Pfizer, Inc. , 500 Arcola Rd, Room B-4207, Collegeville, PA 19426 , USA +1 484 865 4121 ; +1 484 865 8161 ;
| | | | | |
Collapse
|