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Am Fam Physician. 2000;61(7):2225-2226

The use of hormone replacement therapy to reduce cardiovascular disease in postmenopausal women is on the rise. One of the common cardiovascular diseases in postmenopausal women is left ventricular diastolic dysfunction (LVDD). The mechanism for estrogen's positive impact appears to be multifactorial. One possibility suggested in recent studies is that estrogen may improve left ventricular diastolic function. Fak and associates studied the effects of estrogen on left ventricular diastolic function in hypertensive postmenopausal women with diastolic dysfunction.

Postmenopausal women with elevated systemic blood pressure, impaired left diastolic filling and normal or increased left ventricular mass index were included in the study. A control group was used to compare the effect of estrogen on a healthy heart. None of the participants had received hormone replacement therapy before entering the study. The study design was a double-blinded, placebo-controlled crossover study. All of the participants were given 0.625 mg of conjugated estrogen or placebo followed by echocardiography. After a 48-hour washout period, the groups were crossed over. Echocardiography was performed at baseline and three hours after medication.

The estrogen had no effect on heart rate or blood pressure in the participants. In the control group, estrogen had no effect on the cardiac parameters studied. In the group of post-menopausal women with LVDD, estrogen did improve isovolumic relaxation time and the ratio of maximal early and late diastolic flow velocities.

The authors conclude that a single dose of estrogen may improve diastolic filling in hypertensive postmenopausal women. In postmenopausal women with LVDD, estrogen could exert a positive impact on diastolic function. This finding, if verified by other studies, may provide further evidence of the benefits of estrogen replacement therapy with regard to cardiovascular disease in postmenopausal women.

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