New Markers for Cardiovascular Disease Risk in Women: Impact of Endogenous Estrogen Status and Exogenous Postmenopausal Hormone Therapy

Abstract

The role of estrogen in altering cardiovascular disease risk in women is contentious. Menopause is associated with increased risk for ischemic heart disease and cerebrovascular disease, which collectively are the main causes of morbidity and mortality in women of developed nations. Observational studies suggest a protective role of estrogen, whereas recent randomized controlled trials report a negative role for oral estrogen in primary and secondary prevention of cardiovascular events. Inflammatory mechanisms underlie the process of arterial thrombus formation following atheromatous plaque rupture, and as such modulation of the inflammatory process may be a potential means of reducing cardiovascular risk. Sex steroids may influence inflammatory processes and hence modify cardiovascular risk. The objective of the study was to review the current understanding of the relationships between C-reactive protein (CRP), homocysteine, IL-6, and lipoprotein (a) [Lp(a)] and endogenous estrogen status, exogenous estrogen treatment, and cardiovascular disease risk. The design was a review of all relevant published, peer- reviewed studies. Raised levels of CRP, homocysteine, Lp(a), IL-6, and CRP are each independently associated with increased risk for cardiovascular events in women. Changes in these parameters across the menopausal transition cannot clearly be attributed to hormonal changes. With respect to the effects of exogenous postmenopausal therapy, oral estrogen use is consistently associated with elevations in CRP, no change or a reduction in homocysteine, varied effects on IL-6, and a consistent reduction in Lp(a). Transdermal estradiol overall has no significant effect on any of these parameters. Progestin use appears to attenuate the effect of oral estrogen on CRP and is associated with a reduction in Lp(a). Like oral estrogen, tibolone use is associated with a rise in CRP, with no change in homocysteine and consistent lowering of Lp(a). Selective estrogen receptor modulators modestly lower homocysteine and Lp(a), have varied effects on CRP, and have no reported effects on IL-6. Despite these varied effects of postmenopausal hormone treatment on inflammatory markers, homocysteine, and Lp(a), there is no evidence that change in these markers results in modification of cardiovascular risk. Further studies are required to specifically investigate whether treatments that increase or decrease these markers in fact modulate the risk of cardiovascular events in women.

Relation Between Soluble Intercellular Adhesion Molecule-1, Homocysteine, and Fibrinogen Levels and Race/Ethnicity in Women Without Cardiovascular Disease

“…Of note, transdermal HRT does not appear to significantly affect fibrinogen levels (19,22), whereas raloxifene seems to lower fibrinogen levels (20,23). Finally, a majority of reports regarding the effect of HRT on homocysteine concentrations indicate that both oral HRT and raloxifene decrease homocysteine levels (24)(25). …”

Obesity Is an Important Determinant of Baseline Serum C-Reactive Protein Concentration in Monozygotic Twins, Independent of Genetic Influences

“…55,56 Although the route of HRT administration was not known in this study, our previous examination of other cohorts of postmenopausal twins suggests that most used oral preparations. 32 Consistent with previous reports, 19,56 HRT use remained a significant determinant of increased CRP levels in multiple regression analysis, even after accounting for adiposity.…”

Effect of resistance training on C-reactive protein, blood glucose and lipid profile in older women with differing levels of RT experience

“…Among the risk factors, serum blood levels of glucose and lipids profile have been shown to be of a greater impact on cardiovascular disease risk in women compared to men (Roeters van Lennep et al 2002;Tan et al 2010). Chronic inflammation has also been implicated as playing a role in cardiovascular disease (Davison and Davis 2003). To this end, elevations in C-reactive protein (CRP), an inflammation biomarker, may be considered an important independent indicator of mortality for cardiovascular and metabolic diseases (Kengne et al 2012;Pai et al 2004).…”