title: Hormone replacement therapy with estradiol valerate and cyproterone acetate: effects on endothelium-dependent vasodilatation and arterial wall compliance.
abstract: OBJECTIVE
  to evaluate changes in vasomotor endothelium function and elastic properties of the brachial artery in postmenopausal women beginning hormone replacement therapy (HRT) with Climen(R), a 28-day sequential therapy combining estradiol valerate (E2V) 2 mg/day D1-D21 with cyproterone acetate (CPA) 1 mg/day D12-D22, followed by a 7-day treatment-free interval.
  
  
  METHODS
  Thirty-one women with natural or surgical menopause were included in an open multicenter study. Before treatment, at the end of the estrogen-only phase of cycle 1, and after the combined phase in cycles 1 and 3, endothelium-dependent vasodilatation (EDVD%) in the brachial artery was measured by the post-ischemia increase of the inner diameter, and pulse wave velocity (PWV) was measured in the same artery by simultaneous continuous wave Doppler and photo-plethysmography.
  
  
  RESULTS
  compared to pre-treatment values, the median increase in EDVD was 14.3% after cycle 1 (P=0.0001) and 27.9% after cycle 3 (P=0.0001). CPA did not alter the effect of E2V on EDVD in cycle 1. Median arterial systolic pressure was unchanged, but median diastolic pressure fell from 70 to 67.5 mmHg (P=0.04) after cycle 3. Median PWV was reduced by 0.76 m/s after cycle 3 (relative reduction -9.3%) (P=0.035). There was a significant correlation between PWV and EDVD changes from pre-treatment values at the end of the 3rd cycle.
  
  
  CONCLUSIONS
  treatment of postmenopausal women with E2V/CPA led to an immediate and significant improvement in endothelium-dependent vasodilatation. The estrogen-related vasomotor effect was not suppressed by the progestogen CPA. The WV changes are consistent with slower improvement of arterial compliance in some women. The non-invasive measurement of EDVD and PWV is a convenient method for the evaluation of both mechanical and functional effects of combination HRT on the arterial wall.
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Center, Nîmes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mares
authors.forename: Michel
authors.initials: M
authors.lastname: Dauzat
authors.forename: Yves
authors.initials: Y
authors.lastname: Abramovici
mesh_terms: D000284:Administration, Oral; D001916:Brachial Artery / Q000187:drug effects* / Q000502:physiology; D016022:Case-Control Studies; D017373:Cyproterone Acetate / Q000008:administration & dosage / Q000494:pharmacology*; D004334:Drug Administration Schedule; D004730:Endothelium, Vascular / Q000187:drug effects / Q000502:physiology; D004958:Estradiol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology*; D015914:Estrogen Replacement Therapy; D005260:Female; D005602:France; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D011673:Pulsatile Flow; D014664:Vasodilation / Q000187:drug effects* / Q000502:physiology
chemical_list: D017373:Cyproterone Acetate; D004958:Estradiol