Noel Bairey Merz, M.D., lead author of the study, said that the association between hormonal abnormalities and coronary disease in the study group of women sheds new light on questions about why women with heart disease tend to fare worse than men. "There are biologically plausible reasons behind these gender differences in coronary disease. If we can further understand those differences we can do better at treating women and men."

The current study began with unexpected findings from another project, the Women's Ischemia Syndrome Evaluation study: Data showed that a surprisingly high percentage of participants had low levels of estrogen and other hormones. Safety monitors were worried that these premenopausal women might have pituitary tumors.
According to Bairey Merz, when referring physicians evaluated the abnormalities, they found that "These women had low estrogen levels and then terribly low follicle stimulating hormone levels." The abnormally low follicle stimulating hormone results had been the trigger for the initial concerns about tumors. The combination of low estrogen with low follicle stimulating hormone levels led researchers to call the condition hypoestrogenemia of hypothalamic origin. The same women also had abnormally low levels of luteinizing hormone.

The statistical correlation eventually established between low estrogen and coronary artery disease is very strong, but the authors stress, "This is a preliminary finding. Our sample size was low. These were correlational analyses, not prospective. There are a lot of things that still need to be answered, but these preliminary data suggest that there could be a very important risk factor." Bairey Merz noted that heart disease deaths are more common than deaths due to breast cancer in premenopausal women such as those in the current study. Thus, if the hormone link is confirmed it could have important public health implications.

Robert Vogel, M.D., who was not part of the research team, said, "The most interesting observation in this study is that it does tend to suggest that estrogen is quite beneficial before menopause, which of course is the exact opposite of what many trials have shown after menopause." Vogel said the study’s direct evidence supports findings of epidemiological studies that estrogen has a protective effect for younger women. Although this study does not explain why the effect might change at menopause, he added, "It adds another piece to what is obviously a very complex evolving story about estrogen."