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Postmenopausal HT reduced markers of endothelial cell activation
Changes reported in E-selectin and soluble intercellular, vascular cell adhesion molecule-1.
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Postmenopausal women with coronary artery disease who were assigned to hormone therapy for 12 months had reductions in soluble intercellular adhesion molecule-1, vascular cell adhesion molecule-1 and E-selectin.
Researchers studied the effects of 12-month HT on soluble cell adhesion molecules in 309 postmenopausal women enrolled in the Estrogen Replacement and Atherosclerosis trial, a double-blind, placebo-controlled study. They randomly assigned postmenopausal women with established CAD to daily unopposed conjugated estrogens 0.625 mg, estrogen plus 2.5 mg of medroxyprogesterone acetate or placebo. Serum markers of endothelial cell activation/injury were measured at baseline and after 12 months of follow-up.
For this analysis, the researchers obtained complete data on 265 women; 175 women completed 12 months of HT. Women assigned to 12 months of HT had a greater 25.6 ng/mL reduction in soluble intercellular adhesion molecule-1 compared with 10.6 ng/mL with placebo. Soluble vascular cell adhesion molecule-1 was also reduced by 80.2 ng/mL and E-selectin by 8.8 ng/mL with HT compared with 28.8 ng/mL and –1.1 ng/mL with placebo.
Conjugated estrogens alone or conjugated estrogens plus medroxyprogesterone acetate did not affect the progression of coronary artery atherosclerosis, according to the study.
“It is clear that inflammatory cytokines are extremely important in CAD and that this may be reflected in circulating soluble markers. Estrogen therapy and estrogen-progestogen therapy, either orally or transdermally, are expected to decrease most inflammatory markers, and this biochemical effect occurs in women with and without prevalence of CAD,” Rogerio A. Lobo, MD, professor of obstetrics and gynecology, Columbia University Medical Center, wrote in an accompanying editorial.
“However, there is no correlation between these changes and clinical endpoints in women with CAD, and whether there is some protective effect in women with more normal arteries remains an open question.”
In addition, the reductions in E-selectin, soluble intercellular adhesion molecule-1 and soluble vascular cell adhesion molecule-1 are approximately 10-fold lower than values reported in previous literature, according to Lobo. – by Katie Kalvaitis
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For more information:
- Menopause. 2008;15:6.
- Menopause. 2008;15:1036-1038.
The study by Yeboah et al looks at possible markers of heart disease. The researchers found in two of three (vascular cell adhesion molecule-1 and E-selectin) a possible decrease in women on hormones (both estrogen therapy and HT analyzed together). They suggested that this may prevent CAD if given prior to plaque buildup.
– Michelle P. Warren, MD
Medical Director, Center for Menopause, Hormonal Disorders and Women’s Health,
Columbia University Medical Center