University of Pittsburgh, Pittsburgh, PA.
Harvard Medical School and Brigham and Women's Hospital, Boston, MA.
Menopause. 2020 Mar;27(3):255-262. doi: 10.1097/GME.0000000000001472.
Heart fat deposition has been linked to atherosclerosis, and both accelerate after menopause. Hormone therapy (HT) may differentially slow heart fat deposition and progression of atherosclerosis, depending on the specific HT agent or its route of administration. Our objective was to evaluate the effects of different HT agents, oral and transdermal, on associations between heart fat accumulation and atherosclerosis progression, measured by carotid intima-media thickness (CIMT), in recently menopausal women from the Kronos Early Estrogen Prevention Study (KEEPS) trial.
KEEPS was a randomized, placebo-controlled trial of the effects of 0.45 mg/d oral conjugated equine estrogens (o-CEE) or 50 mcg/d transdermal 17β-estradiol (t-E2), compared with placebo, on 48 months progression of CIMT. Epicardial adipose tissue (EAT) and paracardial adipose tissue (PAT) volumes were quantified by computed tomography.
In all, 467 women (mean age [SD] 52.7 [2.5]; 78.2% White; 30% on o-CEE, 30.8% t-E2, 39.2% placebo) with heart fat volumes and CIMT at baseline and 48 months were included. EAT and PAT changes were not associated with CIMT progression; however, the assigned treatment significantly modified the association between PAT (but not EAT) change and CIMT progression. In the o-CEE group, adjusted CIMT progression was 12.66 μm (95% confidence interval [CI] 1.80, 23.52) lower than in t-E2 group (P = 0.02), and 10.09 μm (95% CI 0.79, 19.39) lower than in placebo group (P = 0.03), as per 1-SD increase in PAT.
Compared with t-E2, o-CEE appears to slow down the adverse effect of increasing PAT on progression of atherosclerosis. Whether this beneficial association is specific to CEE or to the oral route of CEE administration is unclear and should be assessed further.
心脏脂肪沉积与动脉粥样硬化有关，绝经后两者都会加速发展。激素治疗（HT）可能会根据特定的 HT 药物或其给药途径，不同程度地减缓心脏脂肪沉积和动脉粥样硬化的进展。我们的目的是评估不同的 HT 药物，口服和经皮，对近期绝经的 Kronos 早期雌激素预防研究（KEEPS）试验中颈动脉内膜中层厚度（CIMT）测量的心脏脂肪堆积与动脉粥样硬化进展之间关联的影响。
KEEPS 是一项随机、安慰剂对照试验，比较了 0.45mg/d 口服结合雌激素（o-CEE）或 50mcg/d 经皮 17β-雌二醇（t-E2）与安慰剂对 CIMT 进展 48 个月的影响。通过计算机断层扫描定量测定心外膜脂肪组织（EAT）和心旁脂肪组织（PAT）体积。
共纳入 467 名女性（平均年龄[标准差]52.7[2.5]；78.2%为白人；30%服用 o-CEE，30.8%服用 t-E2，39.2%服用安慰剂），基线和 48 个月时均有心脂肪体积和 CIMT。EAT 和 PAT 的变化与 CIMT 的进展无关；然而，所分配的治疗方案显著改变了 PAT（但不是 EAT）变化与 CIMT 进展之间的关联。在 o-CEE 组中，调整后的 CIMT 进展比 t-E2 组低 12.66μm（95%置信区间[CI]1.80，23.52）（P=0.02），比安慰剂组低 10.09μm（95%CI0.79，19.39）（P=0.03），PAT 每增加 1-SD。
与 t-E2 相比，o-CEE 似乎可以减缓 PAT 增加对动脉粥样硬化进展的不利影响。这种有益的关联是否特定于 CEE 或 CEE 的口服给药途径尚不清楚，需要进一步评估。
