Esterified estrogens combined with methyltestosterone improve emotional well-being in postmenopausal women with chest pain and normal coronary angiograms

Objective: The cardiac syndrome X is described as the triad of angina pecto ris, a positive exercise test for myocardial ischemia, and angiographically smooth coronary arteries. Although syndrome X does not result in an increa sed risk of cardiovascular mortality, the symptoms are often troublesome an d unresponsive to conventional antianginal therapy. The majority of patient s are postmenopausal, and estrogen therapy can alleviate anginal symptoms. We investigated the effect of esterified estrogens combined with methyltest osterone (Estratest) on quality of life in postmenopausal women with syndro me X. Design: Patients were withdrawn from antianginal therapy. Sublingual nitrat es were allowed for treatment of anginal episodes. Patients underwent tread mill testing, and quality of life was assessed by using the Short Form-36 a nd Cardiac Health Profile questionnaires after the women had received 8 wee ks of Estratest or identical placebo in a randomized, double-blind, cross-o ver study. Results: Nineteen patients were randomized, and 16 patients completed the p rotocol. Plasma 17 beta -estradiol concentrations were significantly increa sed by Estratest; however, total testosterone levels were not. The "emotion al" score of the Cardiac Health Profile questionnaire was significantly imp roved after Estratest use compared with placebo (p = 0.03); however, there was no significant change in the Short Form-36 questionnaire for any variab le. Estratest significantly increased systolic blood pressure and rate pres sure product at rest but had no effect on exercise parameters. Time to onse t of chest pain during exercise was also unaffected. Conclusions: We have demonstrated a beneficial effect of Estratest on emoti onal well-being in postmenopausal women with cardiological syndrome X. Ther e was no significant treatment effect on exercise parameters, including tim e to onset of chest pain.