Comparative vascular effects of hormone replacement therapy and raloxifene in women at increased cardiovascular risk.
Hormone replacement therapy (HRT) improves endothelial function in postmenopausal women while the effects of raloxifene, a selective estrogen receptor modulator, are still under debate. The aim of this study was to evaluate endothelium-dependent flow-mediated vasodilatation in the brachial artery and plasma levels of nitrite, nitrate and endothelin-1 in 20 postmenopausal women with increased cardiovascular risk treated with either HRT or raloxifene for 4 weeks in a randomized double-blind single cross-over study. Patients had an endothelium-dependent flow-mediated dilatation of 4% prior to initiation of the study. Treatment with HRT resulted in a 67% increase in dilatation compared with baseline (from a 7.4% increase to a 12.4% increase, p < 0.01). Raloxifene treatment resulted in no change in vasodilatation from baseline. Endothelium-dependent dilatation was significantly improved by HRT compared with raloxifene treatment (12.4+/-0.6% vs. 6.1+/-2.0%; p < 0.01). Compared with baseline values, nitrate plus nitrite levels increased significantly (p < 0.05) with HRT but not with raloxifene. Similarly, endothelin-1 decreased from baseline with both treatments, but only the HRT-induced decrease was statistically significant (p < 0.05). In conclusion, HRT improved endothelial function and reduced plasma levels of endothelin-1 in postmenopausal women at risk of coronary artery disease. These beneficial effects were not shared by raloxifene.
Cerquetani
E
E
Department of Internal Medicine, San Raffaele Hospital, Rome, Italy.
Vitale
C
C
Mercuro
G
G
Fini
M
M
Zoncu
S
S
Rosano
G M C
GM
D000368:Aged; D001916:Brachial Artery / Q000187:drug effects* / Q000502:physiology; D002318:Cardiovascular Diseases / Q000503:physiopathology* / Q000517:prevention & control; D018592:Cross-Over Studies; D004311:Double-Blind Method; D019332:Endothelin-1 / Q000097:blood; D004730:Endothelium, Vascular / Q000187:drug effects; D015914:Estrogen Replacement Therapy; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000494:pharmacology; D008875:Middle Aged; D009566:Nitrates / Q000097:blood; D009573:Nitrites / Q000097:blood; D017698:Postmenopause; D011673:Pulsatile Flow; D020849:Raloxifene Hydrochloride / Q000494:pharmacology*; D020845:Selective Estrogen Receptor Modulators / Q000494:pharmacology*; D016896:Treatment Outcome; D014664:Vasodilation / Q000187:drug effects* / Q000502:physiology
D019332:Endothelin-1; D004966:Estrogens, Conjugated (USP); D009566:Nitrates; D009573:Nitrites; D020845:Selective Estrogen Receptor Modulators; D020849:Raloxifene Hydrochloride; D017258:Medroxyprogesterone Acetate