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Anonymous (reply to Anonymous)

I want to respond to your first sentence as that addresses the subject of the original article by Ms. Robson. Her chest pain responded to estrogen therapy which is what I would have expected. As to estrogen reducing the risk of heart disease and preventing myocardial infarction: The most recent reports of the Women's Health Initiative(WHI) study of women who have had a hysterectomy and who start estrogen within 10 years of losing their ovarian hormones clearly indicate a reduction in coronary heart disease of 40% and reduced mortality of 11/10,000/year. (Manson et al. JAMA 2013;1353-1368). The WHI findings confirm numerous cohort studies since the 1980's (starting with the coronary drug project) showing that treatment with estrogen alone reduces the risk of heart attacks by over 40% and reduces mortality . Estrogen acts in many ways in the wall of arteries to prevent constriction, stabilize blood flow and inhibit the development of atherosclerosis, the underlying cause of most heart attacks. The WHI findings also indicate that the women who received estrogen-only treatment, whatever their age group, showed more than a 20% decrease, compared to women receiving placebo, in the risk of developing breast cancer.
Understanding the actions of hormones used for treating menopause symptoms and preventing disease due to hormone deficiency is complicated. Ms. Robson sticks with the story for use of estrogen to stop her chest pain and describes a "syndrome" seen almost entirely in women which is severe chest pain but absolutely normal findings of tests of coronary arteries and heart function The symptom is scary but, as our cardiology research showed many years ago (Sarrel et al. Angina and normal coronary arteries. Am J Ob Gyn 1992;167:467-472), the treatment of choice is estradiol taken in a way that maintains stable levels of the estrogen.

September 5, 2014 - 7:54am


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