ELITE: Early Versus Late Intervention Trial With Estradiol

December 21, 2022 updated by: Howard N. Hodis, M.D., University of Southern California

Biologic Response of Menopausal Women to 17B-Estradiol

The purpose of this study is to examine the effects of oral 17B-estradiol (estrogen) on the progression of early (subclinical) atherosclerosis and cognitive decline in healthy postmenopausal women.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

The primary hypothesis to be tested is that 17B-estradiol (estrogen) will reduce the progression of early atherosclerosis if initiated soon after menopause when the vascular endothelium (lining of blood vessels) is relatively healthy versus later when the endothelium has lost its responsiveness to estrogen. Ultrasonography will be used to measure the rate of change in the thickness of the carotid artery and cardiac computed tomography (CT) will be used to measure coronary artery calcium and coronary artery lesions. The second hypothesis to be tested is that 17B-estradiol (estrogen) will reduce the progression of cognitive decline if initiated soon after menopause when healthy brain tissue remains responsive to estrogen versus later when brain tissue has lost its responsiveness to estrogen.

A total of 643 (actual; 504 initially proposed) postmenopausal women were randomized according to their number of years since menopause, less than 6 years or 10 years or more, to receive either oral 17B-estradiol 1 mg daily or matching placebo. Women with a uterus will also use vaginal progesterone gel 4% (or placebo gel) the last ten days of each month. The vaginal progesterone will be distributed in a double-blinded fashion along with the randomized treatment so that only women exposed to active treatment will receive active progesterone. As initially proposed, participants will undergo ultrasonography at baseline and every 6 months throughout the 2 to 5 years (average 3 years) of randomized treatment. Participants will also undergo cognitive testing at baseline and after 3 years of randomized treatment. The trial has been extended for an additional 2 to 2.5 years of randomized treatment (overall average randomized treatment of 5 years and range of 2 to 8.5 years). Ultrasonography will continue to be collected every 6 months and upon completion of randomized treatment, participants will undergo cardiac CT for coronary artery calcium and coronary artery lesion measurements. Participants will also undergo a third cognitive testing at the completion of randomized treatment.

Study Type

Interventional

Enrollment (Actual)

643

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • California
      • Los Angeles, California, United States, 90033
        • Atherosclerosis Research Unit, University of Southern California

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • Women with a serum estradiol level 25 pg/ml or less
  • No period for 6 months or more
  • Postmenopausal less than 6 years, OR 10 years or longer

Exclusion Criteria:

  • Clinical signs, symptoms, or personal history of cardiovascular disease
  • Women who have had a hysterectomy only and no oophorectomy (since time from menopause cannot be determined)
  • Diabetes mellitus or fasting serum glucose 140 mg/dL or greater
  • Uncontrolled hypertension (diastolic blood pressure 110 mmHg or greater)
  • Thyroid disease (untreated)
  • Serum creatinine greater than 2.0 mg/dL
  • Plasma triglyceride levels greater than 500 mg/dL
  • Life threatening disease with prognosis less than 5 years
  • Cirrhosis or liver disease
  • History of deep vein thrombosis or pulmonary embolism
  • History of breast cancer
  • Current hormone replacement therapy (HRT)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: 17B-estradiol
Oral 17B-estradiol 1 mg daily
Drug: 17B-estradiol
Oral 17B-estradiol 1 mg daily
Other Names:
  • Estrace
  • Estrogen replacement therapy
  • Estrogen
  • Hormone therapy
  • Hormone replacement therapy
  • Menopausal hormone replacement therapy
Placebo Comparator: Placebo
Matching oral 17B-estradiol placebo daily
Other: Placebo
Matching oral 17B-estradiol placebo daily
Other Names:
  • Matching placebo

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Progression of Subclinical Atherosclerosis
Time Frame: Baseline x 2 and then every 6 months up to 6.7 years
Rate of change in distal common carotid artery (CCA) far wall intima-media thickness (mm per year) in computer image processed B-mode ultrasonograms that were obtained at two baseline examinations (averaged to obtain the baseline CIMT value) and every 6 months during trial follow-up.
Baseline x 2 and then every 6 months up to 6.7 years

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Neurocognitive Function (Global Cognition)
Time Frame: Baseline and at 2.5 years and 5 years
All neuropsychological test scores at baseline and follow-up assessments were standardized ([raw score - mean score]/standard deviation) using the baseline means and standard deviations from the entire ELITE sample. Each of three cognitive composite scores was calculated at baseline and follow-up assessments as the weighted average of the individual donor standardized test scores, weighted by the inverse correlation among tests.The change from baseline (endpoint minus baseline cognitive outcome) was computed for each of the cognitive scores (verbal memory, global cognition, and executive functions). Since the outcome is not a single test but a weighted average of multiple tests, the range is not standard and not reported. Higher scores mean better outcomes.
Baseline and at 2.5 years and 5 years
Coronary Artery Calcium
Time Frame: End of randomized treatment, up to 6.7 years
Number of participants with coronary artery calcium measured by cardiac computed tomography
End of randomized treatment, up to 6.7 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Southern California

Collaborators

National Institute on Aging (NIA)

Investigators

  • Principal Investigator: Howard N. Hodis, M.D., Atherosclerosis Research Unit, University of Southern California

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

July 1, 2004

Primary Completion (Actual)

February 12, 2013

Study Completion (Actual)

March 5, 2013

Study Registration Dates

First Submitted

June 15, 2005

First Submitted That Met QC Criteria

June 15, 2005

First Posted (Estimate)

June 16, 2005

Study Record Updates

Last Update Posted (Actual)

January 18, 2023

Last Update Submitted That Met QC Criteria

December 21, 2022

Last Verified

December 1, 2022

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • AG0025
  • R01AG024154 (U.S. NIH Grant/Contract)

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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