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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article presents data from a multicenter study to compare outcomes of different formulations of estrogenic hormonal treatments in menopausal women. Results of the trial demonstrated a null effect on cardiovascular disease progression in association with hormone treatment, as well as a reduction in menopausal symptoms, and maintenance of bone mineral density.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EMenopause\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHormone Therapy\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EEndocrinology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Metabolic Syndrome\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMenopause\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHormone Therapy\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EVirginia Miller, MBA, PhD, Mayo Clinic, Rochester, Minnesota, USA, presented data from a multicenter study to compare outcomes of different formulations of estrogenic hormonal treatments in menopausal women. Results of the trial demonstrated a null effect on cardiovascular disease (CVD) progression in association with hormone treatment, as well as a reduction in menopausal symptoms, and maintenance of bone mineral density.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EGenetic variations in estrogen metabolism and estrogen receptors account, in part, for the variability in clinical symptoms of menopause such as vasomotor instability and depression, in addition to the variability in response to exogenous hormones.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe modality of hormone delivery impacts the efficacy of the treatments because oral formulations absorbed directly into the hepatic-portal circulation have a different pharmacokinetic and pharmacodynamic profile than transdermal products, which directly enter the systemic circulation for example, oral products have a greater effect on some factors produced by the liver including low- and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively), inflammatory cytokines and proteins of the coagulation cascade [De Lignieres B et al. \u003Cem\u003EJ Clin Endocrinol Metab\u003C\/em\u003E 1986; Scarabin PY et al. \u003Cem\u003ELancet.\u003C\/em\u003E 2003; Bush TL et al. \u003Cem\u003ECirculation\u003C\/em\u003E 1987].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EData from observational studies suggested that hormone therapy administered at menopause decreased risk factors for CVD and its adverse events [Grodstein F et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 1996; Psaty BM et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E 1994; Falkeborn M et al. \u003Cem\u003EBr J Obstet Gynaecol\u003C\/em\u003E 1992; Hunt K et al. \u003Cem\u003EBr J Obstet Gynaecol\u003C\/em\u003E 1990; Criqui MH et al. \u003Cem\u003EAm J Epidemiol\u003C\/em\u003E 1988; Bush L et al. \u003Cem\u003ECirculation\u003C\/em\u003E 1987].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe Kronos Early Estrogen Prevention Study [KEEPS; Harman SM et al. \u003Cem\u003EClimacteric\u003C\/em\u003E 2005] was a multicenter, randomized, placebo-controlled, 4-year trial to compare the effectiveness of oral and transdermal estrogenic hormonal formulations (both accompanied by an oral progesterone), and placebo, in preventing progression of atherosclerosis as measured by carotid intimal medial thickness in women aged 42 to 58 years who were within 36 months of their final menstrual period. Secondary outcomes included coronary arterial calcification, blood lipids and inflammatory markers, and changes in menopausal symptoms and sexual function. Seven hundred and twenty-eight women were enrolled in the trial, and 584 completed it.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EIn the oral formulation group (conjugated equine estrogen 0.45 mg\/day), levels of HDL-C were increased, and LDL-C were decreased, compared with those in the transdermal formulation (50 \u03bcg\/day 17\u03b2-estradiol) and placebo groups. However, there was no significant effect on CVD progression. This null effect on progression of carotid intimal medial thickening, however, at least indicates that CVD was not accelerated by hormonal treatment over 4 years. Additional treatment effects in women taking estrogen\/progesterone included a reduction of menopausal symptoms (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) and prevention of bone loss (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E) [Farr JN et al. \u003Cem\u003EJ Clin Endocrinol Metab\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/10\/24\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Changes in Menopausal Symptoms Throughout the KEEPS Trial\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1922597795\u0022 data-figure-caption=\u0022Changes in Menopausal Symptoms Throughout the KEEPS Trial\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/10\/24\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/10\/24\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/10\/24\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13326\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EChanges in Menopausal Symptoms Throughout the KEEPS Trial\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced from Farr JN et al. \u003Cem\u003EJ Clin Endocrinol Metab\u003C\/em\u003E 2013. With permission from The Endocrine Society.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/10\/24\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Changes in Bone Mineral Density Throughout the KEEPS Trial\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1922597795\u0022 data-figure-caption=\u0022Changes in Bone Mineral Density Throughout the KEEPS Trial\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/10\/24\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/10\/24\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/10\/24\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13328\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EChanges in Bone Mineral Density Throughout the KEEPS Trial\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced from Farr JN et al. \u003Cem\u003EJ Clin Endocrinol Metab\u003C\/em\u003E 2013. With permission from The Endocrine Society.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EDr. Miller concluded by emphasizing the need for further exploration of emerging data to determine whether hormonal treatment does have a preventive effect on CVD progression over a longer time period. She also stressed the importance of avoiding generalizations about the effects of hormone treatments in this era of personalized treatments. In particular, the different types, doses, and delivery modes of hormone treatments must be carefully considered in order to maximally impact the individual health of patients.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/10\/24.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznou1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznou1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}