PITTSBURGH—While heart fat deposition has been linked to atherosclerosis—with both accelerating after menopause—hormone therapy might be able to change how that occurs.

A study published in the journal Menopause examined how hormone therapy differentially slowed heart fat deposition and progression of atherosclerosis, depending on the specific HT agent or its route of administration.

Specifically, University of Pittsburgh researchers and colleagues from the Phoenix, AZ, VA Health Care System institutions, said they sought “to evaluate the effects of different HT agents, oral and transdermal, on associations between heart fat accumulation and atherosclerosis progression, measured by carotid intima-media thickness (CIMT), in recently menopausal women from the Kronos Early Estrogen Prevention Study (KEEPS) trial.”

That randomized, placebo-controlled trial tracked the effects of 0.45 mg/d oral conjugated equine estrogens (o-CEE) or 50 mcg/d transdermal 17β-estradiol (t-E2), compared with placebo, on 48 months progression of CIMT. Computed tomography was used to quantify epicardial adipose tissue (EAT) and paracardial adipose tissue (PAT) volumes. KEEPS included 467 women—78.2% white, mean age 52.7—with heart fat volumes and CIMT at baseline and 48 months. Of the participants, 30% were on o-CEE, 30.8% on t-E2 and 39.2% on placebo.

Results indicated that EAT and PAT changes were not associated with CIMT progression, but that the assigned treatment significantly modified the association between PAT—although not EAT—change and CIMT progression.

Researchers pointed out that, in the o-CEE group, adjusted CIMT progression was 12.66 μm (95% confidence interval [CI] 1.80, 23.52) lower than in t-E2 group (P = 0.02), and 10.09 μm (95% CI 0.79, 19.39) lower than in placebo group (P = 0.03), as per 1-SD increase in PAT.

“Compared with t-E2, o-CEE appears to slow down the adverse effect of increasing PAT on progression of atherosclerosis,” the authors concluded. “Whether this beneficial association is specific to CEE or to the oral route of CEE administration is unclear and should be assessed further.”

  1. El Khoudary SR, Venugopal V, Manson JE, et al. Heart fat and carotid artery atherosclerosis progression in recently menopausal women: impact of menopausal hormone therapy: The KEEPS trial [published online