Cardiac benefit remains relevant in these patients, particularly in the absence of evidence that any one hormone replacement regimen is better than others for preventing bone resorption. Although prospective trials are needed to show differences between treatment regimens, any significant increase in HDL would be predicted favourable. In the PEPI trial, it was oral doses of conjugated equine estrogen that were tested. Transdermal estrogen would not be expected to provide the same degree of cardiovascular benefits, because this method of delivery is not as effective for elevating plasma HDL, which appears to be a key mediator of risk in women. The reason may be that it does not undergo significant first-pass hepatic metabolism.
Further testing is needed to evaluate effects on other cardiovascular parameters.
We also need to document the cardioprotection predicted by the PEPI results. The Writing Group for the PEPI Trial. Medical Education Network Canada Inc. All rights reserved. Any comments or suggestions, please contact the Webmaster Haining Yu.