CLINICAL STUDIES
Estrogen is associated with improved survival in aging women with congestive heart failure: analysis of the vesnarinone studies
Steven E. Reis, MD, FACC*,
Richard Holubkov, PhD*,
James B. Young, MD, FACC ,
B. G. White, PhD ,
Jay N. Cohn, MD, FACC and
Arthur M. Feldman, MD, PhD, FACC*
* University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Cleveland Clinic Foundation, Cleveland, Ohio, USA
Clinical Cardiovascular Research, Gaithersburg, Maryland, USA
University of Minnesota, Minneapolis, Minnesota, USA
Manuscript received September 24, 1999;
revised manuscript received January 20, 2000,
accepted March 29, 2000.
Reprint requests and correspondence: Dr. Steven E. Reis, Cardiovascular Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213
OBJECTIVES
This study sought to evaluate the effects of postmenopausal estrogen use on mortality in aging women with congestive heart failure (CHF).
BACKGROUND
The age-related increase in CHF mortality in women may be related to a menopause-associated increased incidence of coronary artery disease. In addition to inhibiting coronary atherosclerosis, estrogen may also have protective effects on cardiac myocytes independent of the coronary vasculature. We hypothesized that estrogen use is associated with improved survival in elderly women with CHF.
METHODS
Associations between survival, estrogen use and patient characteristics were assessed in 1,134 women who were at least 50 years of age, had CHF and left ventricular ejection fraction (EF)  30% and were enrolled in one of three clinical trials of vesnarinone.
RESULTS
All-cause 12-month mortality was 15.0% among the 237 estrogen users versus 27.1% among the 897 estrogen nonusers (p = 0.004 for unadjusted comparison of survival). Similar results were observed for cardiac mortality. Regression analysis demonstrated that estrogen use was independently associated with improved survival (relative risk of mortality = 0.68, 95% confidence interval 0.48 to 0.96, p = 0.03). Advanced age, low EF, New York Heart Association class IV CHF, Caucasian race and abnormal serum creatinine, sodium, potassium and transaminase were independently associated with increased mortality.
CONCLUSIONS
Estrogen use among older women with CHF is associated with decreased overall and cardiac mortality.
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Abbreviations and Acronyms
| | AST | = serum aspartate aminotransferase | | CAD | = coronary artery disease | | CHF | = congestive heart failure | | EF | = ejection fraction | | HERS | = Heart and Estrogen/progestin Replacement Study | | NYHA | = New York Heart Association | | RR | = relative risk |
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