Hormone replacement therapy may improve pulmonary hypertension and right ventricular function

Medical Xpress / American Thoracic Society / ATS 2024 International Conference ^ | May 19, 2024 | Audriana Hurbon, MD et al

[ConservativeMind]

The use of hormone replacement therapy (HRT) may be associated with improved pulmonary hypertension in women, according to research. Pulmonary hypertension (PH) is a type of pulmonary vascular disease—disease that affects blood vessels along the route between the heart and lungs.

Pulmonary hypertension is classified by the World Symposium on Pulmonary Hypertension (WSPH) into five groups (G1-5PH) based on its suspected cause. The heart's right ventricle accepts blood from the body's veins and propels it to the lungs, where it is oxygenated, and its carbon dioxide is eliminated.

For this study's purposes, endogenous hormones were deemed to be those that women's bodies produce prior to menopause, while exogenous hormones were introduced through HRT.

Participants in the research were enrolled in the Pulmonary Vascular Disease Phenomics (PVDOMICS) study.

In WSPH Group 1 pulmonary hypertension (G1PH), being a woman has been associated with better preservation of right ventricular function than in men.

The study included 742 women from G1-5PH, comparators (those who have risk factors for pulmonary hypertension but do not have this disease), and healthy controls.

Endogenous hormone exposure was quantified by duration of self-reported lifetime duration of menses and exogenous exposure by ever having taken HRT. Two statistical analyses were done: One (all pulmonary hypertension groups) and two-way (by both pulmonary hypertension group and exposure) to examine differences in pulmonary vascular disease or right ventricular function.

The results: Across all pulmonary hypertension groups, average pulmonary arterial pressure decreased with greater lifetime duration of menses. Use of HRT was associated with lower mean pulmonary artery pressure and higher right ventricular fractional shortening and right ventricular ejection fraction.

G1PH had lower mean pulmonary artery pressure and pulmonary vascular resistance and higher right ventricular ejection fraction with hormone replacement therapy exposure. The team did not detect statistical differences within WSPH Groups 2-5.

[ConservativeMind]

Hormone replacement therapy may help minimize pulmonary hypertension, in women.

[ConservativeMind]

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[swingdoc]

The WHI study may go down in history as one of the most poorly constructed yet widely accepted of our time. In multiple observational studies prior, women’s cardiovascular and bone health was noted to be better on HRT. The WHI wanted to ask if women should be started on HRT for the purpose of reducing ASCVD due to its well known observational status. However, the WHI had several serious flaws, and the outcomes started to show higher ASCVD events in HRT patients. So much so, that the trial was stopped early and a tidal shift of treatment recommendations came down in one fell swoop. HRT bad, HRT dangerous, stop HRT. Which everyone did. Despite poor symptom control of menopause, fast forward 2 decades and women are experiencing higher rates of osteoporosis and pathologic fracture as well as worsening ASCVD outcomes. It’s crazy, one study, o matter how poor its methodology and all of the heavy criticism in opposition to its conclusions can create a sea change in an entire field of high persists despite emerging evidence to the contrary.