Author/Editor     Žegura, Branka; Keber, Irena; Šebeštjen, Miran; Koenig, Wolfgang
Title     Double blind, randomized study of estradiol replacement therapy on markers of inflammation, coagulation and fibrinolysis
Type     članek
Source     Atherosclerosis
Vol. and No.     Letnik 158
Publication year     2003
Volume     str. 123-9
Language     eng
Abstract     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-a) 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.
Descriptors     ESTROGEN REPLACEMENT THERAPY
HYSTERECTOMY
ESTRADIOL
LIPOPROTEINS
BLOOD COAGULATION TESTS
DOUBLE-BLIND METHOD
RANDOMIZED CONTROLLED TRIALS
FIBRINOLYSIS
CLOT RETRACTION
PLASMINOGEN ACTIVATORS
PLASMINOGEN INACTIVATORS
FIBRINOGEN
C-REACTIVE PROTEIN
AMYLOID
INTERLEUKIN-6
TUMOR NECROSIS FACTOR