Use of the Drug Nebivalol in Combination with Hormonal Replacement Therapy in Women with Stable Angina with Intact Coronary Arteries

Coronary heart disease is the main cause of death in women in European countries. Women more likely than men meet obstructive form of CHD. The aim of the study was to examine the effectiveness of hormone replacement therapy in combination with the drug nebivalol women with stable angina with intact coronary arteries. The data of 26 perimenopausal women with intact coronary artery disease and positive treadmill test was analysed. The patients were divided into two groups depending on the type of therapy. In group 1 there were 13 women treated with β-blocker nebivalol in combination with HRT (estradiol + 2 mg dydrogesterone 10 mg). In group 2 there were 13 patients who received only 10 mg of nebivalol. The diagnosis of ischemic heart disease was verified in the presence of positive stress test (treadmill test) and intact coronary arteries on angiography. The severity of symptoms of menopause was assessed using a Cooperman's questionnaire modified by Uvarova. During the combined treatment with HRT and nebivalol in patients the extension of time in the load (from (369,5 (315,0 ÷ 399,5) with up to 394,5 (363,0 ÷ 419,5) with p = 0,03 ), the time until the segment depression ST (from 336,0 (285,0 ÷ 376,5) with up to 360,0 (290,0 ÷ 399,0) with p = 0,015) and the index of METs (6,9 (6,15 ÷ 10,0) to 9,0 (7,0 ÷ 10,55), p = 0,028) was specified. In the group of women receiving only nebivolol there was a significant increase in time until the segment depression ST (from 335,0 ( 295,0 ÷ 365,0) with up to 343,0 (300,0 ÷ 384,0) with p = 0,034) and an indicator of VO2 (from 7,0 (4,8 ÷ 10,0) to 7,5 ( 7,0 ÷ 11,0) METs, p=0,03). In the group receiving the combination of HRT and nebivolol after the observation period parameters VO2 (W, p = 0,039), and run-time load (W, p = 0,044) were significantly higher than in the group receiving only nebivolol. Menopausal index in group 1 before the treatment was 39,0 (32,0 ÷ 47,2) and after the treatment - 27,0 (21,0 ÷ 30,1), in group 2 before the treatment it was 38,5 (39,1 ÷ 36,4) and 28,0 (18,0 ÷ 30,0) after the treatment. It was revealed that the combined use of nebivolol and HRT leads to a significant increase in tolerance to physical exercises in women with intact coronary arteries perimenopausal compared to isolated treatment with nebivolol. Also, this combination is effective to control the symptoms of menopause.