Beneficial effect of treatment with transdermal estradiol-17-β on exercise-induced angina and ST segment depression in syndrome X

We investigated the acute effect of transdermal estradiol-17-β on exercise-induced ischemia in 15 postmenopausal women (mean age 58 ± 6 years) with syndrome X (angina pectoris, positive exercise test and normal coronary angiogram) and eight healthy women (mean age 58 ± 5 years) in a placebo-controlled, double-blind crossover trial. Two exercise tests were performed on separate days, separated by at least 1 week, after application of placebo or 100 μg/24 h estradiol-17-β. In the control group there was no difference between estradiol and placebo. Patients with syndrome X, on the other hand, showed an increased time to angina (323 ± 99 versus 233 ± 67 s, P = 0.0044), time to 1 mm ST depression (257 ± 142 versus 187 ± 122s, P = 0.039), total exercise time (363 ± 104 versus 323 ± 85 s, P = 0.038), and working capacity (93 ± 17 versus 89 ± 15W, P = 0.0086) during active treatment. In conclusion, estradiol-17-β has a beneficial effect on myocardial ischemia in postmenopausal women with syndrome X and may be a useful therapeutic agent in this disease.