Effects of Hormone Therapy on Heart Fat and Coronary Artery Calcification Progression: Secondary Analysis From the KEEPS Trial

Samar R. El Khoudary, Qian Zhao, Vidya Venugopal, Jo Ann E. Manson, Maria M. Brooks, Nanette Santoro, Dennis M. Black, S. Mitchell Harman, Marcelle I. Cedars, Paul N. Hopkins, Ann E. Kearns, Virginia M. Miller, Hugh S. Taylor, Matthew J. Budoff

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: Heart fats (epicardial and paracardial adipose tissue [PAT]) are greater after menopause. Endogenous estrogen may regulate these fat depots. We evaluated the differential effects of hormone therapy formulations on heart fat accumulations and their associations with coronary artery calcification (CAC) progression in recently menopausal women from KEEPS (Kronos Early Estrogen Prevention Study). Methods and Results: KEEPS was a multicenter, randomized, placebo-controlled trial of the effects of 0.45 mg/d oral conjugated equine estrogens and 50 µg/d transdermal 17β-estradiol, compared with placebo, on 48-month progression of subclinical atherosclerosis among 727 early menopausal women. CAC progression was defined if baseline CAC score was 0 and 48-month CAC score was >0 or if baseline CAC score was >0 and <100 and annualized change in CAC score was ≥10. Of 727 KEEPS participants, 474 (mean age: 52.7 [SD: 2.6]; 78.1% white) had computed tomography–based heart fat and CAC measures at both baseline and 48 months. Compared with women on placebo, women on oral conjugated equine estrogens were less likely to have any increase in epicardial adipose tissue (odds ratio for oral conjugated equine estrogens versus placebo: 0.62 [95% CI, 0.40–0.97]; P=0.03). PAT did not change in any group. Changes in epicardial adipose tissue and PAT did not differ by treatment group. CAC increased in 14% of participants. The assigned treatment modified the association between PAT changes and CAC progression (P=0.02) such that PAT increases were associated with CAC increases only in the transdermal 17β-estradiol group. Conclusions: In recently menopausal women, oral conjugated equine estrogens may slow epicardial adipose tissue accumulation, whereas transdermal 17β-estradiol may increase progression of CAC associated with PAT accumulation. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00154180.

Original languageEnglish (US)
Article numbere012763
JournalJournal of the American Heart Association
Issue number15
StatePublished - Aug 6 2019


  • coronary artery disease
  • epicardial fat
  • estrogen
  • menopause

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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