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Oral Estrogen May Increase Body Fat

February 2004

A study from Brazil suggests that oral estrogen replacement therapy may decrease lean body mass and increase total body fat mass in certain women.

The researchers examined 23 postmenopausal women who had previously undergone a hysterectomy.* Thirteen of the women took oral-conjugated estrogen pills, while the other 10 used “transdermal” estrogen skin patches.

The researchers found that the women taking the oral pills demonstrated a decrease in lean body mass, an increase in total body fat mass, no change in total bone mass or total bone mineral density, and a decrease in lipid oxidation. The patch-using women demonstrated an increase in lean body mass, no change in total body fat mass, an increase in total bone mass and in total bone mineral density, and an increase in lipid oxidation. Neither group exhibited a significant change in weight, visceral adipose tissue areas, or energy expenditure.

Some of these findings may be related to the fact that oral estrogen decreased insulin-like growth factor 1 (IGF-1) levels while transdermal estrogen had no effect on IGF-1.

The researchers concluded that “lean body mass loss associated [with] oral estrogen could be related to a chronic suppression of IGF-1 levels which, in turn, plays a major endocrinological role thanks to its powerful anabolic action, as well as nitrogen retention [and] protein synthesis stimulation, especially in muscle cells, thus preventing protein catabolism.”


* dos Reis CM, de Melo NR, Meirelles ES, Vezozzo DP, Halpern A. Body composition, visceral fat distribution and fat oxidation in postmenopausal women using oral or trans dermal oestrogen. Maturitas. 2003 Sep 25;46(1):59-68.

Estrogen-Progestin Therapy Fails to Slow Atherosclerosis

A recent study found that estrogen-progestin therapy failed to slow the progression of coronary-artery atherosclerosis (plaques in the arteries that feed the heart muscle) in postmenopausal women with the disease.

For their study dubbed the Women’s Estrogen-Progestin Lipid-Lowering Hormone Atherosclerosis Regression Trail (WELL-HART), researchers randomly assigned 226 postmenopausal women with known coronary-artery atherosclerosis to one of three groups: a control group that received “usual care,” an estrogen group that received 17b-estradiol therapy, or an estrogen-progestin group that received the 17b-estradiol plus medroxyprogesterone.*

The study found no significant difference between the three groups in the progression of atherosclerosis as seen on the cardiac angiograms.

The researchers noted, however, that these results are “strikingly different” from those of the Estrogen in the Prevention of Atherosclerosis Trial (EPAT) study, in which oral 17b-estradiol alone slowed thickening of the carotid artery wall. The time from menopause was 5-10 years less in the EPAT study than in the WELL-HART study, however, which suggests that hormone replacement therapy may play a role in preventing coronary artery disease early after menopause, but may become detrimental after a certain number of years.


* Hodis HN, Mack WJ, Azen SP, et al. Hormone therapy and the progression of coronary-artery atherosclerosis in post- menopausal women. N Engl J Med. 2003 Aug 7;349(6):535-45.

For Heart-Attack Victims, Angioplasty Worth the Wait

New research suggests that angioplasty is superior to clot-busting drugs in the treatment of acute heart attacks.
A heart attack occurs when one or more coronary arteries that feed the heart muscle becomes suddenly clogged and the heart muscle begins to die. Angioplasty is an invasive procedure in which cardiologists, guided by x-rays, open clogged coronary arteries by feeding a catheter to the heart from an artery in the groin.

A study published in the New England Journal of Medicine suggests that angioplasty is superior to fibrinolytic therapy (clot-busting drugs), even if the patient has to be transferred to another hospital before initiating treatment.*

Researchers in Denmark randomly assigned more than 1,500 heart-attack patients to treatment with angioplasty or fibrinolytic therapy. They discontinued the study earlier than planned when it was determined that patients who received angioplasty fared much better, even if it took up to two hours to receive treatment.

The researchers found that patients who received angioplasty were 75% less likely to have another heart attack during the 30-day study period than those receiving fibrinolytic therapy, and were therefore less likely to die or suffer from a disabling stroke.

“A strategy for reperfusion involving the transfer of patients to an invasive-treatment center for primary angioplasty is superior to onsite fibrinolysis, provided that the transfer takes two hours or less,” the researchers concluded.

In an editorial accompanying the article, Alice K. Jacobs, MD, a cardiologist at the Boston University Medical Center, stressed the importance of recognizing heart-attack symptoms and immediately activating emergency medical systems when symptoms do occur.

“When available and performed by experienced operators at high-volume centers, primary percutaneous coronary intervention [angioplasty] saves 20 lives and results in 60 fewer events for every 1,000 patients treated,” wrote Jacobs. “This suggests that primary percutaneous coronary intervention is indeed worth the wait.”

Editor’s Note: In the Disease Prevention and Treatment protocol book, Life Extension has advocated angioplasty over fibrinolytic therapy for years. As stated above, recognizing heart-attack symptoms and immediately calling for an ambulance are the most important steps you can take in the event of a heart attack.


* Andersen HR, Nielsen TT, Rasmussen K, et al. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003 Aug 21;349(8):733-42. Comment: 798-800.