Oral Estradiol Therapy Associated With Less Progression of Subclinical Atherosclerosis

HealthDay News – Oral estradiol therapy is associated with less progression of subclinical atherosclerosis in postmenopausal women when therapy is initiated early in menopause, according to a study published in the March 31 issue of the New England Journal of Medicine.

Howard N. Hodis, MD, from the University of Southern California, Los Angeles, and colleagues randomly assigned 643 healthy postmenopausal women to receive either oral 17β-estradiol (1 mg/day, plus progesterone [45 mg] vaginal gel administered sequentially for women with a uterus) or placebo (plus sequential placebo vaginal gel for women with a uterus). Change in carotid-artery intima-media thickness (CIMT) was measured every 6 months.

Researchers found that among women who were less than 6 years past menopause at the time of randomization, the mean CIMT increased significantly more per year in the placebo group than in the estradiol group (P=.008). The rates of CIMT progression in the placebo and estradiol groups were similar (P=.29) among women who were 10 or more years past menopause at the time of randomization. 

There were no differences between the placebo and estradiol groups in either post-menopause stratum with regard to computed tomography measures of coronary artery calcium, total stenosis, and plaque.

“Oral estradiol therapy was associated with less progression of subclinical atherosclerosis (measured as CIMT) than was placebo when therapy was initiated within 6 years after menopause but not when it was initiated 10 or more years after menopause,” the authors wrote.


  1. Hodis HN, Mack WJ, Henderson VW, et al; for the ELITE Research Group. Vascular effects of early vs late postmenopausal treatment with estradiol. N Engl J Med. 2016;374:1221-1231. doi: 10516/NEJMoa1505241.
  2. Keaney JF, Solomon CG. Postmenopausal hormone therapy and atherosclerosis—time is of the essence. N Engl J Med. 2016;374:1279-1280. doi: 10.1056/NEJMe1602846.