Vasomotor hot flashes and cardiac repolarization: A randomized placebo-controlled trial of postmenopausal hormone therapy

Hanna Lantto, Petri Haapalahti, Matti Viitasalo, Heikki Väänänen, Anssi R.A. Sovijärvi, Olavi Ylikorkala, Tomi S. Mikkola*

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Objective: The aim of the study was to compare the effects of different hormone therapies on cardiac repolarization in recently postmenopausal women with and without hot flashes. Methods: We recruited 150 healthy women: 72 with and 78 without hot flashes. They were randomized and treated for 6 months with transdermal estradiol (1 mg/day), oral estradiol (OE) alone (2 mg/day) or combined with medroxyprogesterone acetate (MPA; 5 mg/day), or placebo. Cardiac repolarization was assessed by measuring QT intervals, rate-dependence of QT-end interval, and T waves from 24-hour electrocardiographic recording before and during hormone therapy, comprising a total of over 20 million QT-interval measurements. Results: Hot flashes were accompanied with shortened median T-peak - T-end interval (at RR interval of 700, 800, and 900 ms; P = 0.040, 0.020, and 0.032; η2 = 0.35, 0.39, and 0.37; respectively) during the use of OE but not transdermal estradiol. In contrast, the addition of MPA to OE lengthened the maximal QT-end (at RR interval of 500 ms, P = 0.016, η2 = 0.27) and the maximal T-peak - T-end interval (at RR interval of 500 and 600 ms; P = 0.016 and 0.032; η2 = 0.25 and 0.22, respectively). These effects were not seen in women without hot flashes. Conclusions: Hot flashes predict beneficial shortening in cardiac repolarization during OE, but not if MPA is combined with OE. These data may provide one explanation for MPA-related cardiac hazards in epidemiological studies.

Original languageEnglish
Pages (from-to)1386-1391
Number of pages6
JournalMenopause
Volume24
Issue number12
DOIs
Publication statusPublished - 1 Dec 2017
MoE publication typeA1 Journal article-refereed

Keywords

  • Arrhythmia
  • Electrocardiography
  • Estrogen
  • Menopause
  • QT interval
  • Vasomotor symptom

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