Beneficial effect of treatment with transdermal estradiol-17-beta on exercise-induced angina and ST segment depression in syndrome X.

We investigated the acute effect of transdermal estradiol-17-beta on exercise-induced ischemia in 15 postmenopausal women (mean age 58 +/- 6 years) with syndrome X (angina pectoris, positive exercise test and normal coronary angiogram) and eight healthy women (mean age 58 +/- 5 years) in a placebo-controlled, double-blind crossover trial. Two exercise tests were performed on separate days, separated by at least 1 week, after application of placebo or 100 micrograms/24 h estradiol-17-beta. In the control group there was no difference between estradiol and placebo. Patients with syndrome X, on the other hand, showed an increased time to angina (323 +/- 99 versus 233 +/- 67 s, P = 0.0044), time to 1 mm ST depression (257 +/- 142 versus 187 +/- 122 s, P = 0.039), total exercise time (363 +/- 104 versus 323 +/- 85 s, P = 0.038), and working capacity (93 +/- 17 versus 89 +/- 15 W, P = 0.0086) during active treatment. In conclusion, estradiol-17-beta has a beneficial effect on myocardial ischemia in postmenopausal women with syndrome X and may be a useful therapeutic agent in this disease.