Abstract Background Atorvastatin is widely used to reduce cardiovascular events in patients with chronic atherosclerotic coronary artery disease (CAD). However, the absolute rates of reduction of these events are lower in women even though they are, on average, older and have a higher burden of cardiovascular risk factors compared to men. This reduced efficacy may be linked to the drug’s influence on serum concentrations of endogenous oestrogens. In postmenopausal women, estrone is the predominant endogenous oestrogen and, although less potent than oestradiol, has demonstrated protective effects against atherosclerosis. Purpose To analyse the impact of atorvastatin on serum oestradiol and estrone concentrations in postmenopausal women with chronic atherosclerotic CAD. Methods A randomized, double-blind, placebo-controlled study lasting 60 days included 38 natural postmenopausal women who were less than 70 years old with chronic CAD. Natural menopause was defined as one year of amenorrhea and CAD in the presence of at least one major coronary artery with more than 50% luminal reduction. The participants were divided into a placebo group and an atorvastatin (80 mg/day) group. Before randomization, they underwent a 40-day washout without lipid-lowering drugs, maintaining their usual dietary pattern. Clinical and laboratory assessments were performed at baseline and after 60 days, including triglycerides, total cholesterol, HDL, LDL, glucose, glycated haemoglobin, C-reactive protein, oestradiol, and estrone. Results The mean age of the postmenopausal women was 61±5.05 years, with 17 (45%) in the atorvastatin group and 21 (55%) in the placebo group. Baseline characteristics were similar between the two groups. The Table below presents the mean ± SD values for body mass index and serum concentrations of total cholesterol, HDL, LDL, glucose, glycated haemoglobin (HbA1c), C-reactive protein (CRP), oestradiol, and estrone in each group. Plasma estrone concentration significantly decreased in the atorvastatin group, from 3.4±1.3 to 2.8±0.8 ng/mL (p=0.010) (Figure). Conclusion Atorvastatin reduced serum estrone concentrations, which may partly explain the lower efficacy of statins in postmenopausal women. Future studies with more participants and longer follow-ups are needed to confirm these findings and clarify the mechanisms involved.Table Figure
Faria et al. (Sat,) studied this question.