The effect of 17beta-estradiol on endothelial and inflammatory markers in postmenopausal women: a randomized, controlled trial.
BACKGROUND
Intervention trials in postmenopausal women with coronary artery disease have failed to demonstrate beneficial effects of hormone replacement therapy (HRT) on the course of disease, potentially due to pro-inflammatory effects of conjugated equine estrogens. We characterized the effects of 48 weeks treatment with two estradiol-based HRT regimens on nonspecific (high sensitivity C-reactive protein [hs-CRP], blood sedimentation rate [BSR], fibrinogen) and specific endothelial markers (cell adhesion molecules: ICAM-1, VCAM-1, E-selectin).


RESULTS
Postmenopausal women randomly received either 1 mg 17beta-estradiol daily plus 25 microg gestodene for the last 12 days of each 28 day cycle (=standard dose progestin; n=65), or gestodene added each third cycle only (=low dose progestin; n=65), or no HRT (n=73). Both HRT regimens reduced levels of ICAM-1 (-9%), VCAM-1 (-9%), E-selectin (-11%), fibrinogen (-12%), BSR (-5%). No effect was observed on hs-CRP levels in any group. In smokers, E-selectin remained unchanged whereas ICAM-1 and VCAM-1 were lowered. Subjects on antihypertensive or lipid lowering medication showed effects comparable to the whole cohort. Effects of low and standard dose progestin were not different.


CONCLUSIONS
We conclude that a combination therapy with 1 mg 17beta-estradiol favourably affects the vascular inflammation processes as indicated by a neutral effect on hs-CRP and reduction of cell adhesion molecules.
Störk
Stefan
S
Medizinische Klinik, Klinikum der Ludwig-Maximilians Universität München-Innenstadt, München, Germany. s.stoerk@medizin.uni-wuerzburg.de
von Schacky
Clemens
C
Angerer
Peter
P
D000328:Adult; D000368:Aged; D001161:Arteriosclerosis / Q000097:blood / Q000150:complications*; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation / Q000187:drug effects; D002097:C-Reactive Protein / Q000187:drug effects; D002340:Carotid Artery Diseases / Q000097:blood* / Q000209:etiology; D015815:Cell Adhesion Molecules / Q000097:blood* / Q000187:drug effects; D004958:Estradiol / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D045167:Progesterone Congeners / Q000008:administration & dosage / Q000494:pharmacology*
D015415:Biomarkers; D015815:Cell Adhesion Molecules; D045167:Progesterone Congeners; D004958:Estradiol; D002097:C-Reactive Protein