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Life Extension Magazine

LE Magazine August 2005

Women and Coronary Heart Disease

A Novel Approach to Coronary Heart Disease Prevention By Dr. Sergey Dzugan

These studies used standard doses of powerful synthetic hormones for women of different ages and weights, without evaluating each woman’s levels of various hormones either before or during treatment. Conventional HRT likewise usually uses hormones in a continuous or sequential manner. In this case, hormones were administered throughout the month or estrogen was recommended for the first two weeks alone and together with progestin for the next two weeks. Because hormone levels are constantly changing, however, the body’s physiology needs estrogens and progesterone on a daily basis, and doses must be customized to suit each woman’s particular requirements. The “one-size-fits-all” method of HRT used in the HERS II and WHI studies seems likely to generate side effects or long-term problems by not accounting for or addressing the unique needs of each participant.

Thus, current problems with conventional HRT can be summarized as follows:

  • The majority of studies have used only one or two agents (estrogen or estrogen/progestin replacement therapies are most often used).
  • Conventional HRT generally does not attempt to mimic the physiology of the menstrual cycle by administering hormones cyclically. (Normally, levels of estrogens and progesterone rise and fall throughout the menstrual cycle, while menopausal women experience a similar but less pronounced cycle.) Most conventional HRT dosing is based on a “one-size-fits-all” approach, since most FDA-approved hormone analogs are manufactured in fixed doses.
  • Conventional HRT generally uses hormones that are not bioidentical to those found in humans.
  • Serum hormone levels are not used to guide treatment recommendations.
  • Most physicians and studies use only orally administered hormones. When a woman takes a hormone orally, the liver will metabolize and modify this hormone such that it may no longer exert the desired effect in the body. Transdermal delivery systems (gel or cream) allow administered hormones to bypass the liver’s metabolic effects and exert their desired effects without biochemical conversion to other hormones.

The three main treatments for coronary heart disease (CHD) are drugs, surgical procedures that open blocked arteries (for example, coronary angioplasty), and heart bypass surgery. None of these treatments, however, cures heart disease.

• Medication is often the first step used in treating CHD. People with high cholesterol, high homocysteine, high blood pressure, or diabetes must follow the treatment plan prescribed by their physician. Some drugs such as statins, fibrates, niacin, and hormone replacement therapy (HRT) drugs may help lower high cholesterol. Other drugs can relax the arterial wall, lower heart rate and blood pressure, control diabetes, “thin” the blood, and prevent blood clots. The most commonly used medicines for these purposes are nitroglycerin, beta-blockers, calcium antagonists, aspirin, Glucophage® (metformin HCl), and Glucotrol XL® (glipizide). All these drugs can slow down CHD progression or lessen the chances of suffering a heart attack. Lifestyle modifications such as a healthy diet, regular exercise, and quitting smoking may be used in conjunction with medication.

• In case of cardiac emergency, “clot-busting” drugs must be administered, preferably within two hours after onset of a heart attack. Treatment is most effective if given soon after the heart attack begins. Drugs such as streptokinase and tissue plasminogen activator can quickly dissolve clots, open arteries, reverse the heart attack, and save the heart muscle from damage.33,34

• A procedure called coronary or balloon angioplasty is often used to open a narrowed artery. A special catheter with a tiny balloon at its tip usually is inserted into an artery in the groin or forearm, then threaded through the blocked area. This opens the obstruction mechanically. Sometimes a small metal mesh tube (stent) is placed in the narrowed area to keep an artery open after angioplasty.

• If blockages cannot be corrected by angioplasty or if angioplasty does not adequately improve arterial blood flow, coronary artery bypass surgery may be required. In a bypass procedure, a blood vessel is taken from another part of the body to make a “bridge” or detour around the closed area in the artery.

• When other treatments have not worked well or cannot be used, a procedure called revascularization may be suggested. A laser or a needle is used to make small holes or channels in the heart muscle. This appears to help grow new blood vessels by stimulating a process called angiogenesis, thus increasing blood supply to the muscle.

Principles of Hormonorestoration

The chemical structure of the hormones used in hormonorestoration should be identical to human hormones. Normal ratios among hormones in each hormone group (for example, the estrogen group) are maintained. Triest, which includes all three major estrogens—estriol, estradiol, and estrone—is the preferable form of estrogens. The combination of all deficient hormones—pregnenolone, DHEA, progesterone, estrogens, and testosterone—should be used instead of just one or two hormones, the method often employed by conventional medical practitioners. Using a combination of hormones allows us to use smaller doses of each and provide hormonal balance.

While many of the patented prescription hormones available in pharmacies are bioidentical, not all of the crucial estrogens are available as patented drugs. For example, estradiol is a bioidentical hormone available as a patented prescription drug, but if it is used without estriol and estrone, serious problems may result. Since estriol is not currently available as a patented “estrogen” drug, it can be obtained only by filling a doctor’s prescription at a compounding pharmacy. Thus, it may be impossible to achieve the optimal balance of estrogens using only patented prescription medications.

When using the term “bioidentical,” it is important to specify that these hormones are bioidentical to those naturally found in humans. The prescription drug Premarin®, for example, contains conjugated estrogens that are “bioidentical” for horses, but not for humans.

The preferable delivery system for administering bioidentical hormones is topical gels containing highly lipophilic molecules of low molecular weight that can be readily absorbed through the skin. This delivery system allows for individualized doses.

Thus, some basic principles of hormonorestoration include:

  • Using hormones that are bioidentical in structure to human hormones
  • Using individualized doses
  • Dosing in a cyclical manner
  • Using larger doses of hormones in the morning
  • Using poly- or multi-hormonal therapy as the optimal approach, as opposed to mono- or bi-hormonal therapy, which is usually inadequate.
  • Hormone replacement in women should begin as soon as hormone levels have diminished below the optimal levels of a 20- to 30-year-old woman. As with other health problems, it is advisable to address and treat hormonal imbalance as soon as possible.
  • Among the important questions to ask your physician when considering a hormonorestorative program to help protect your cardiovascular health are these:
  • Should I have my blood tested to determine whether I need to take hormones, and what tests are appropriate?
  • How can I know if hormono-restorative therapy is appropriate for me?
  • How many hormones do you generally prescribe as part of hormone restoration therapy?
  • Do you prescribe hormones that are bioidentical to human hormones?
  • What is the prescribed formula for estrogens and who would prepare it?
  • How are the hormones administered (oral, transdermal, injections, pellets) and why?
  • How will you monitor the optimal dosage of hormones during treatment (clinical symptoms, blood, saliva, or urine test)?
  • Do you use individually modified doses?
  • Do you prescribe programs of hormone therapy that mimic the physiology of the menstrual cycle?
  • If I suffer from other health problems, can I use hormonorestorative therapy, and which form of medication should I take?
  • Who should not use hormones, and why?
  • What are the benefits of hormone restoration? What are the risks?
  • What side effects can I expect?
  • How long should I be on hormone restorative therapy?

Blood tests are essential in developing a safe and effective hormonorestorative program. When your doctor considers prescribing insulin, he first checks your glucose level. A similar approach should be employed for hormonorestoration. Dose recommendations for different patients should be determined by serial testing of serum hormone levels. Doses can be individually modified during treatment to produce ideal youthful physiological serum levels.

Heart Disease Death Rates, Adults Aged 35 and Older, by County 1996–2000

Sources: National Vital Statistics System, CDC, and the U.S. Census Bureau.

While physicians can prescribe a hormone restoration program, patients may need to adjust dosages as their clinical symptoms change. After a few months on hormono-restoration, most women are able to do this by themselves, making their own minimal changes in dosages according to their needs. When you are under stress, exercising, or performing intensive mental work, your body may require more hormones. While blood tests are important, they should always be evaluated in a clinical context. For example, we have observed that progesterone does not work always exactly as might be expected. If, during replacement therapy, you use a larger dose than your body requires, progesterone may be converted first to androstenedione and then to estradiol. This could lead to stimulation of the sympathetic nervous system, and instead of a diuretic and relaxing effect (for example, improved sleep), the opposite effect may occur.

As previously noted, several risk factors contribute to the onset of CHD. If a physiologically based approach to hormone restoration helps to eliminate several of these risk factors, the risk of CHD should decrease. As also noted earlier, recent studies have found that conventional HRT actually increases CHD risk.19,20 In our experience, however, the appropriate use of hormonorestorative therapy with bioidentical hormones actually decreases several CHD risk factors.

In the two cases we are about to describe, we achieved complete control of blood pressure, glucose and cholesterol levels, and psychosocial symptoms. We believe that individualized hormonorestoration of five essential steroid hormones, based on clinical symptoms and blood tests, is a more effective strategy for decreasing CHD risk than is standard HRT using two synthetic drugs. For optimal safety and efficacy, physicians and patients must monitor hormone levels regularly, usually three months after beginning treatment and then every six months thereafter.

The following two cases demonstrate how an anti-aging program featuring physiological hormonorestoration can help women reduce their CHD risk factors.


Coronary heart disease (CHD) can lead to angina (chest pain) and myocardial infarction (heart attack). A heart attack occurs when blood supply to the heart muscle is suddenly cut off and heart muscle cells begin to die.

The most common symptoms of heart attack include discomfort, pressure, or pain in the center of the chest that usually lasts more than a few minutes and may come and go. The pain often spreads to the left arm or both arms, the back, abdomen, or jaw. Many people also experience shortness of breath, weakness, nausea, vomiting, and cold sweats.

However, not everyone experiences these typical symptoms. Women have an atypical clinical picture more often than men do, which can include unusual fatigue, anxiety, trouble sleeping, shortness of breath, and indigestion.

Several tests can be used to help diagnose CHD:

• The most commonly used test is an electrocardiogram (EKG), which records the heart’s electrical activity and can detect myocardium (heart muscle) damage or irregular heartbeat. In addition to routine EKG, a stress test is important because it monitors the heart’s rate and rhythm, as well as breathing and blood pressure during exercise on a treadmill.

• Another frequently used test is coronarography, a computerized x-ray that can help reveal coronary artery blockages by using a contrast fluid.

• Other kinds of tests that may help detect early-stage CHD include ultrasound, echocardiography, and electron beam tomography. If you have any CHD risk factors or signs of heart attack, your physician may suggest these tests.

• Creatine kinase is the blood test most commonly used to confirm heart muscle damage.

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