Skip to main content


Cardiovascular magnetic resonance measures of coronary artery blood flow improve after receipt of oral conjugated estrogen and/or high dose atorvastatin in early post-menopausal women without known coronary arteriosclerosis


To determine the effect of oral hormone replacement with conjugated equine estrogens (CEE, 0.625 mg po qd) and/or high dose atorvastatin (ATORV, 80 mg po qd) on submaximal exercise induced coronary artery blood flow (CABF) in relatively early postmenopausal women without documented coronary artery disease (CAD).


Oral conjugated equine estrogens and HMG-CoA reductase inhibitor (statin) therapy have been shown to enhance arterial endothelial function, but the effect of these agents on submaximal coronary artery blood flow is unknown.


We randomized 56 postmenopausal women aged 59 ± 3 years without evidence of coronary arteriosclerosis, into a randomized double blinded, cross-over study in which women were assigned to receive 8 weeks of oral CEE 0.625 mg or placebo, with or without 80 mg per day of ATORV. Each treatment period was separated by a 6 week "washout" period of no treatment. Prior to receipt of any therapy, and after each treatment period, each woman underwent rest/submaximal exercise measures of CABF in the left anterior descending coronary artery using phase contrast cardiac magnetic resonance imaging at 1.5 T. Exercise was performed on an electronically braked bike (Lode, Netherlands). Scan parameters included an 8-mm-thick slice, a 256 × 256 matrix, a 20-cm FOV, a through-plane velocity encoding of 150 cm/s, a 13.8-ms TR, and a 6.7-ms TE.


Of 56 women, 47 were compliant with therapy (85% of administrated medication) and their results are displayed below (least square mean ± standard error).


In early postmenopausal women without coronary arteriosclerosis, the administration of conjugated equine estrogens 0.625 mg, Atorvastatin 80 mg, or their combination have favorable effects on resting and/or submaximal exercise-induced coronary artery blood flow (Figure 1).

Figure 1

Left anterior descending coronary artery blood flow (ml/min).

Author information

Correspondence to Chirapa Puntawangkoon.

Rights and permissions

Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and Permissions

About this article


  • Atorvastatin
  • Cardiovascular Magnetic Resonance
  • Cardiac Magnetic Resonance
  • Conjugate Equine Estrogen
  • Early Postmenopausal Woman