Beneficial Effect of Oestrogen on Exercise-Induced Myocardial Ischaemia in Women With Coronary Artery Disease

Lancet. 1993 Jul 17;342(8864):133-6. doi: 10.1016/0140-6736(93)91343-k.

Abstract

Oestradiol-17 beta causes relaxation of isolated coronary arteries and increases blood flow in several vascular beds in human beings and animals. Oestrogen replacement therapy is associated with a lower incidence of cardiovascular disease, but the acute effects of oestradiol-17 beta on myocardial ischaemia are unknown. We have studied the acute effect of sublingual oestradiol-17 beta on exercise-induced myocardial ischaemia in eleven women (mean age 58 [SD 8] years) with coronary artery disease. The women did two treadmill exercise tests on separate days; 40 min before the test they took sublingual oestradiol-17 beta (1 mg) or placebo, in random order. Plasma oestradiol-17 beta concentrations were confirmed to be higher after sublingual oestradiol-17 beta than after placebo (2531 [1192] vs 155 [168] pmol/L, p < 0.001). Oestradiol-17 beta increased both time to 1 mm ST depression (456 [214] vs 579 [191] s, p < 0.004; difference of medians 92 [95% CI 46-254]) and total exercise time (569 [249] vs 658 [193] s, p < 0.01; difference 54 [10-212]). Acute administration of oestradiol-17 beta therefore has a beneficial effect on myocardial ischaemia in women with coronary artery disease. This effect may be due to a direct coronary-relaxing effect, to peripheral vasodilation, or to a combination of these mechanisms. Oestradiol-17 beta may prove to be a useful adjunct to the treatment of angina in postmenopausal women with coronary heart disease.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Sublingual
  • Angina Pectoris / physiopathology
  • Blood Pressure / drug effects
  • Blood Pressure / physiology
  • Coronary Disease / pathology
  • Coronary Disease / physiopathology*
  • Coronary Vessels / drug effects
  • Coronary Vessels / pathology
  • Electrocardiography / drug effects
  • Estradiol / administration & dosage
  • Estradiol / blood
  • Estradiol / therapeutic use*
  • Exercise Test
  • Female
  • Heart Rate / drug effects
  • Heart Rate / physiology
  • Humans
  • Middle Aged
  • Myocardial Ischemia / physiopathology
  • Myocardial Ischemia / prevention & control*
  • Placebos
  • Time Factors

Substances

  • Placebos
  • Estradiol