Double blind, randomized study of estradiol replacement therapy on markers of inflammation, coagulation and fibrinolysis.
Estrogen replacement therapy (ERT) has been found to be associated with increased cardiovascular risk in the first year after initiation of ERT. We compared the effects of oral and transdermal estradiol (E2) replacement therapy on markers of inflammation, coagulation and fibrinolysis in a randomized double-blind trial. Forty-three healthy women were randomized 6 weeks after surgically induced menopause to receive treatment with either oral or transdermal E2 over a period of 28 weeks. At baseline and after 28 weeks, levels of serum lipids and lipoproteins, and markers of coagulation, fibrinolysis and inflammation were determined. Among fibrinolytic parameters, oral E2 shortened euglobulin clot lysis time (P<0.05) and reduced tissue type plasminogen activator antigen (P=0.01) and plasminogen activator inhibitor activity (P<0.05). Among coagulation parameters, both routes of E2 replacement decreased fibrinogen levels (P=0.002 for oral and P=0.007 for transdermal E2). Oral E2 resulted in an increase in C-reactive protein (CRP) from 2.15 (0.71-4.05) to 3.41 (1.12-5.92) mg/l (P=0.04), while transdermal E2 showed no effect. Levels of serum amyloid A (SAA), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) did not change significantly after oral and transdermal E2. Oral E2 significantly improved the lipid profile, while transdermal E2 had a less pronounced effect. Both oral and transdermal E2 significantly reduced fasting glucose. Oral E2 was associated with a pro-inflammatory response, but at the same time improved fibrinolytic capacity, showed no pro-coagulatory effects, and acted beneficially on lipids and lipoproteins. There was no influence of transdermal E2 on markers of coagulation activation, fibrinolysis and inflammation, but it decreased fibrinogen levels significantly. Further studies are needed to explore the clinical relevance of these observations.
Clinical Department of Gynecology and Obstetrics, Maribor Teaching Hospital, Ljubljanska 5, Slovenia. branka.zegura@guest.arnes.si
Branka
B
Zegura
Irena
I
Keber
Miran
M
Sebestjen
Wolfgang
W
Koenig
D000279:Administration, Cutaneous; D000284:Administration, Oral; D000328:Adult; D001777:Blood Coagulation / Q000187:drug effects*; D008076:Cholesterol, HDL / Q000378:metabolism; D008078:Cholesterol, LDL / Q000378:metabolism; D004311:Double-Blind Method; D004958:Estradiol / Q000627:therapeutic use*; D015914:Estrogen Replacement Therapy; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism*; D008593:Menopause / Q000187:drug effects / Q000378:metabolism; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000378:metabolism; D011446:Prospective Studies; D012016:Reference Values; D010959:Tissue Plasminogen Activator / Q000378:metabolism; D014280:Triglycerides / Q000378:metabolism; D016387:Women's Health
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D018836:Inflammation Mediators; D017395:Plasminogen Activator Inhibitor 1; D014280:Triglycerides; D004958:Estradiol; D010959:Tissue Plasminogen Activator