Cardiometabolic outcomes in Kronos Early Estrogen Prevention Study continuation: 14-year follow-up of a hormone therapy trial

OBJECTIVE

This study aimed to determine long-term cardiometabolic effects of hormone therapies initiated within 3 years of onset of menopause after a 14-year follow-up study of participants of the Kronos Early Estrogen Prevention Study (KEEPS).

METHODS

KEEPS was a multisite clinical trial that recruited recently menopausal women with good cardiovascular health for randomization to oral conjugated equine estrogens (Premarin, 0.45 mg/d) or transdermal 17β-estradiol (Climara, 50 μg/d) both with micronized progesterone (Prometrium, 200 mg/d) for 12 d/mo, or placebo pills and patch for 4 years. KEEPS continuation recontacted KEEPS participants 14 years after randomization and 10 years after the completion of the 4-year clinical trial to attend in-person clinic visits.

RESULTS

Participants of KEEPS continuation (n = 299 of the 727 KEEPS participants; 41%) had an average age of 67 years (range, 58-73 y). Measurements of systolic and diastolic blood pressures, waist-to-hip ratio, fasting levels of glucose, insulin, lipid profiles, and homeostasis model assessment of insulin resistance were not different among the treatment groups at either KEEPS baseline or at KEEPS continuation visits, or for change between these two visits. The frequency of self-reported diabetes ( P = 0.007) and use of diabetes medications was higher in the placebo than the oral conjugated equine estrogens ( P = 0.045) or transdermal 17β-estradiol ( P = 0.02) groups, but these differences were not supported by the laboratory measurements of glycemia or insulin resistance.

CONCLUSIONS

There was no evidence of cardiovascular and/or metabolic benefits or adverse effects associated with 4 years use of oral or transdermal forms of hormone therapy by recently menopausal women with good cardiovascular health after 10 years.

Estrogen receptors in ovarian epithelial carcinoma

Specimens from 53% (16 of 30) of patients with untreated ovarian epithelial cancers between October 1976 and February 1979 had estrogen binding levels greater than 30 fmoles/mg of cytosol protein (receptor rich). The likelihood of a specimen being receptor rich appeared to be independent of patient age, histologic grade of tumor, clinical stage, and amount of residual tumor left after surgery. For 20 patients with previously untreated advanced disease a life-table analysis showed no significant difference when receptor-rich and -poor groups were compared in terms of either survival or time to first progression of disease. Analysis of more recent specimens (predominantly obtained after February 1979) indicates high-affinity binding of the estrogen consistent with receptor; occasional substantial heterogeneity in estrogen binding results between different sites of tumor involvement; and progestin-specific binding in some specimens. In an analogy to breast cancer, patients whose tumors are cytosol estrogen receptor rich might theoretically be responsive to the administration of antiestrogens.