title: Low-dose oral or non-oral hormone therapy: effects on C-reactive protein and atrial natriuretic peptide in menopause.
abstract: OBJECTIVE
  To assess the effects of oral low-dose and non-oral hormone therapy (HT) on ultra-sensitive C-reactive protein (CRP), atrial natriuretic peptide (ANP), and cardiovascular risk factors in postmenopause.
  
  
  METHODS
  In this randomized, cross-over study, 44 recently postmenopausal women, with no clinical evidence of cardiovascular disease, received oral low-dose HT (estradiol 1 mg + drospirenone 2 mg/day) for 3 months. Forty-two patients received non-oral, conventional HT (1.5 mg/day percutaneous 17β-estradiol gel or equivalent for nasal route) for 3 months followed by 200 mg/day micronized progesterone by the vaginal route (14 days during each menstrual period). After 3 months, patients were crossed over without washout. Post-HT vs. pre-HT measures were determined: lipids, glucose, body mass index, waist circumference, fibrinogen, CRP-stratified levels, and ANP levels. The study was registered at clinical trials.gov (NCT01432028).
  
  
  RESULTS
  The mean age was 51 ± 3 years and the mean time since the menopause was 22 ± 10 months. CRP-stratified high levels decreased in a higher number of non-oral HT patients, who moved to intermediate and low levels (p = 0.02). No effect of HT was observed on ANP levels (baseline 67.4 (18.4-104.5), low-dose oral 43.5 (14.4-95.9), non-oral 39.8 (15.5-67.5) pg/ml). Markers of endothelial function did not worsen with either low-dose oral or non-oral HT: von Willebrand factor (baseline 118 ± 37%, low-dose oral 119 ± 38%, non-oral 108 ± 3%, p < 0.01), fibrinogen (baseline 356 ± 58 mg/dl; low-dose oral 343 ± 77 mg/dl; non-oral 326 ± 71 mg/dl, p < 0.01).
  
  
  CONCLUSIONS
  Low-dose oral and non-oral HT for 6 months had neutral or beneficial effects in recently postmenopausal women with no clinical evidence of cardiovascular disease.
authors.affiliation: * Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre , Porto Alegre , Brazil.
authors.forename: G
authors.initials: G
authors.lastname: Casanova
authors.forename: A M
authors.initials: AM
authors.lastname: dos Reis
authors.forename: P M
authors.initials: PM
authors.lastname: Spritzer
mesh_terms: D000279:Administration, Cutaneous; D000281:Administration, Intranasal; D000284:Administration, Oral; D000736:Androstenes / Q000008:administration & dosage*; D009320:Atrial Natriuretic Factor / Q000187:drug effects* / Q000378:metabolism; D002097:C-Reactive Protein / Q000187:drug effects* / Q000378:metabolism; D002318:Cardiovascular Diseases; D018592:Cross-Over Studies; D004338:Drug Combinations; D004958:Estradiol / Q000008:administration & dosage*; D015914:Estrogen Replacement Therapy / Q000379:methods*; D005260:Female; D005782:Gels; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause / Q000187:drug effects*; D012307:Risk Factors
chemical_list: D000736:Androstenes; D004338:Drug Combinations; D005782:Gels; C488382:estradiol-drospirenone combination; D004958:Estradiol; D009320:Atrial Natriuretic Factor; D002097:C-Reactive Protein
keywords: ATRIAL NATRIURETIC PEPTIDE; C-REACTIVE PROTEIN; CARDIOVASCULAR RISK; HORMONE THERAPY; MENOPAUSE; RANDOMIZED CLINICAL TRIAL