title: Hormone replacement therapy does not affect plasma homocysteine in postmenopausal women with coronary artery disease. Free tissue factor pathway inhibitor antigen, a circulating anticoagulant, is related to plasma homocysteine.
abstract: OBJECTIVE
  The objective was to evaluate the effect of hormone replacement therapy (HRT) on plasma homocysteine levels in postmenopausal women with coronary artery disease (CAD) and to investigate associations of homocysteine to other cardiovascular risk factors.
  
  
  METHODS
  The women in this single-center, controlled, and randomized study were examined at baseline, and after 3 and 12 months, after they had been recruited consecutively from patients referred for investigational coronary angiography. All analyses were performed examiner blind. They were randomized to HRT consisting of transdermal application of continuous 17beta-estradiol with cyclic medroxyprogesterone acetate (MPA) tablets for 14 days every 3rd month, or to a control group.
  
  
  RESULTS
  After 3 months of unopposed 17beta-estradiol, no significant effect on homocysteine was observed compared to the control group. The absolute decrease of 5% in median plasma homocysteine levels after 12-month HRT did not reach statistical significance. Plasma homocysteine seemed slightly higher in women with three- or four-vessel disease, but the difference was not significant. With increasing homocysteine levels, free tissue factor pathway inhibitor (TFPI) antigen increased, whereas E-selectin decreased. In women with diabetes or elevated blood glucose >6.0 mmol/l, plasma homocysteine was correlated to body mass index, C-peptide and insulin as well as age.
  
  
  CONCLUSIONS
  Transdermal application of 17beta-estradiol and sequential MPA do not affect plasma homocysteine in women with established CAD. Plasma homocysteine is stable in women with CAD over time, and unless special intervention is undertaken, repetitive measurements are not necessary in this particular group of high-risk individuals. The circulating anticoagulant TEPI is related to plasma homocysteine.
authors.affiliation: Department of Internal Medicine, Ullevål University Hospital, Oslo, Norway. ingrid.os@ioks.uio.no
authors.forename: Ingrid
authors.initials: I
authors.lastname: Os
authors.forename: Audun
authors.initials: A
authors.lastname: Os
authors.forename: Per Morten
authors.initials: PM
authors.lastname: Sandset
authors.forename: Silje
authors.initials: S
authors.lastname: Bølling
authors.forename: Ingebjorg
authors.initials: I
authors.lastname: Seljeflot
authors.forename: Srdjan
authors.initials: S
authors.lastname: Djurovic
authors.forename: Arne
authors.initials: A
authors.lastname: Westheim
mesh_terms: D000279:Administration, Cutaneous; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002096:C-Peptide / Q000097:blood / Q000187:drug effects; D003324:Coronary Artery Disease / Q000097:blood* / Q000188:drug therapy*; D019040:E-Selectin / Q000097:blood / Q000187:drug effects; D004958:Estradiol / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D005260:Female; D006710:Homocysteine / Q000097:blood* / Q000187:drug effects*; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood / Q000187:drug effects; D017270:Lipoprotein(a) / Q000097:blood / Q000187:drug effects; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use; D008875:Middle Aged; D017698:Postmenopause / Q000097:blood* / Q000187:drug effects*; D045167:Progesterone Congeners / Q000627:therapeutic use; D012720:Severity of Illness Index; D013997:Time Factors; D016212:Transforming Growth Factor beta / Q000097:blood / Q000187:drug effects; D053773:Transforming Growth Factor beta1; D016896:Treatment Outcome; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood / Q000187:drug effects; D016387:Women's Health
chemical_list: D015415:Biomarkers; D002096:C-Peptide; D019040:E-Selectin; D017270:Lipoprotein(a); D045167:Progesterone Congeners; C508960:TGFB1 protein, human; D016212:Transforming Growth Factor beta; D053773:Transforming Growth Factor beta1; D019010:Vascular Cell Adhesion Molecule-1; D006710:Homocysteine; D018799:Intercellular Adhesion Molecule-1; D004958:Estradiol; D017258:Medroxyprogesterone Acetate