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Key Publications in Cardiovascular Health

Study Examples | Key Publications | Intro

A few key publications follow:

In this study, conjugated equine estrogens (Premarin) increased the risk of blood clots in the legs of postmenopausal women. Esterified estrogens were not associated with an increase in risk. The data from this observational study suggest that various types of estrogen compounds may have different risks for adverse events such as blood clots.

—Smith NL, Heckbert SR, Lemaitre RN, Reiner AP, Lumley T, Weiss NS, Larson EB, Rosendaal FR, Psaty BM (2004). Esterified estrogens and conjugated equine estrogens and the risk of venous thrombosis. Journal of the American Medical Association, 292: 1581–1587.

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For people with high blood pressure, the best medication to try first is a low dose of a diuretic such as hydrochlorothiazide (HCTZ). Based on the evidence from over 40 studies, these drugs are more effective at preventing heart attack, stroke, and death from cardiovascular disease than are other first-line treatments such as beta-blockers.

—Psaty BM, Lumley T, Furberg CD, Schellenbaum G, Pahor M, Alderman MH, Weiss NS (2003). Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. Journal of the American Medical Association, 289 (19): 2534–2544.

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A certain variant in the gene for alpha-adducin has been linked to the kind of high blood pressure that is associated with salt in the diet. In people who carry this mutation and have high blood pressure, the risk of having a heart attack or stroke is lower when people take diuretics such as HCTZ than when they take other antihypertensive medications.

—Psaty BM, Smith NL, Heckbert SR, Vos HL, Lemaitre RN, Reiner AP, Siscovick DS, Bis J, Lumley T, Longstreth WT Jr, Rosendaal FR (2002). Diuretic therapy, the alpha-adducin variant, and the risk of myocardial infarction or stroke in persons with treated hypertension. Journal of the American Medical Association, 287 (13): 1680–1689.

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For the first two months after starting HRT, postmenopausal women with coronary disease at Group Health Cooperative are twice as likely to have a heart attack; but after they have taken HRT for more than a year, their heart attack risk is actually lowered by about one quarter, compared to those not taking HRT. These findings confirm and extend those of the Heart and Estrogen/Progestin Replacement Study (HERS).

—Heckbert SR, Kaplan RC et al. (2001). Risk of recurrent coronary events in relation to use and recent initiation of postmenopausal hormone therapy. Archives of Internal Medicine, 161 (July 23): 1709–1713.

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When women with hypertension after menopause take HRT, their risk of having a heart attack is seven times higher if they have the inherited variant in the prothrombin gene, which makes a clotting protein, than if they do not. This jibes with estrogen’s tendency to promote blood clotting, and with recent reports suggesting that women with blood-clotting mutations might be most likely to get heart attacks soon after starting HRT.

—Psaty BM, Smith NL, Lemaitre RN, Vos HL, Heckbert SR, LaCroix AZ, Rosendaal FR (2001). Hormone replacement therapy, prothrombotic mutations, and the risk of incident nonfatal myocardial infarction in postmenopausal women. Journal of the American Medical Association, 285 (7): 906–913.

Study Examples | Key Publications | Intro

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