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Am Fam Physician. 2001;63(4):728

Congestive heart failure (CHF) is one of the leading causes of death in the elderly. Recent reports have indicated that estrogen may have a positive impact on the myocardium. Because prior studies have limited the number of women enrolled, there is insufficient information regarding the outcome in elderly women with CHF and the effect of menopause-related estrogen loss on these patients. Reis and colleagues studied the impact of postmenopausal estrogen use on the mortality of aging women with CHF.

Of the women with symptomatic CHF who were older than 50 years, 1,134 were enrolled in the study. Those included in the study had symptoms consistent with CHF and a left ventricular ejection fraction of 30 percent or less. Estrogen users were using oral or transdermal estrogen alone or in combination with progesterone. The outcome measured was the relative risk of mortality, both cardiac and all-cause, in estrogen users and nonestrogen users.

The all-cause mortality rate in nonusers was 27 percent versus 15 percent in the estrogen-user group, a statistically significant difference. In addition, similar rates were found for cardiac mortality, and these, too, were statistically significant. Regression analysis of the data revealed that estrogen use was independently associated with improved survival rates.

The authors conclude that estrogen use among older women with CHF is associated with decreased overall and cardiac mortality rates. They also noted that this was a retrospective study that generates a new hypothesis and that it needs to be tested by a large-scale, prospective randomized clinical trial.

editor's note: Again, physicians are provided with a new study suggesting that estrogen replacement therapy does have a positive impact on cardiac disease in women. However, the authors point out that this study was a retrospective analysis, and further studies need to be performed. Currently, the information regarding the effect of estrogen on cardiac disease appears to be mixed, with positive results in some studies and negative results in others. When discussing the risks and benefits of estrogen replacement therapy with patients, physicians need to provide balanced information concerning the impact of this hormone on the cardiac system.—k.e.m.

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