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C-reative protein and HRT
Title:The effects of hormone replacement therapy and raloxifene on c-reactive protein and homocystcinc in healthy postmenopausal women: a randomized, controlled trial
Author: B. Walsh, et al.
Address: Boston, MA
Source: The Journal of Clinical Endocrinology & Metabolism 85: 214-218 (January) 2000
Summary: Epidemiological observations suggest that estrogen treatment has benefits such as a 50% decrease in the incidence of cardiovascular disease compared to that in nonusers. Surprisingly, the Heart and Estrogen/Progestin Replacement Study (HERS), to date the only randomized clinical trial of HRT for the secondary prevention of cardiovascular disease, did not confirm this long-held belief. Although treatment reduced the low-density lipoprotein levels, there were significantly more cardiovascular events in the hormone group compared with the placebo group during the first year. Elevated levels of C-reactive protein, a circulating marker of inflammation, predict future myocardial infarction, ischemic stroke, and peripheral arterial disease. Moderate elevations in circulating homocysteine levels also predict a significantly greater risk of coronary artery disease. Raloxifene seems to confer some of the positive benefits of estrogen.
Comment: C-reactive protein is rapidly emerging as a marker of cardiovascular disease risk. Unfortunately, the special sensitive assay for CRP is not widely available. This is troubling news about estrogen replacement not providing the protection we once thought. It is too soon to draw conclusions and should not alter prescribing.