Abstract. 2-Methoxyestradiol (2-ME) is an endogenous metabolite of estradiol with no affinity for estrogen receptors. It inhibits cell proliferation, thus is a potentially useful drug to block the progression of atherosclerosis. As a first step to examining the anti-atherosclerotic effects of 2-ME, we investigated monocyte adhesion to aortic endothelial cells, which is considered a prerequisite to atherosclerosis in vivo. Eight-week-old Sprague-Dawley rats were ovariectomized then treated by slow-release pellets with placebo, 17-β-estradiol (5 µg/day), low-dose 2-ME (10 µg/day), or high-dose 2-ME (100 µg/day). After 6 weeks, enface analysis showed an increased number of monocytes adhering to endothelial cells of the thoracic aorta in ovariectomized rats compared with sham-operated controls. This increase was predominantly inhibited by treatment with 17β-estradiol, and low-dose or high-dose 2-ME. The observed effects were unrelated to changes in serum lipids, blood glucose, or blood pressure. Our data suggested that 2-ME mediates the anti-atherosclerotic actions of estradiol at least in part by preventing monocyte adhesion to the aortic endothelium. CARDIOVASCULAR disease is a major cause of morbidity and mortality in modern societies. In women, menopause increases the risk of cardiovascular disease [1, 2], probably due to reduced estrogen levels [3][4][5]. Hormone replacement therapy is reported to delay the onset of cardiovascular disease in postmenopausal women [6,7]. In contrast, two major randomized prospective clinical trials, the Heart and Estrogen/progestin Replacement Study (HERS) [8] and the Women's Health Initiative Study (WHI) [9], found that hormone replacement therapy increased the risk of cardiovascular disease following menopause. This discrepancy might reflect differences in study conditions. The efficacy of hormone replacement therapy to protect against atherosclerosis seems dependent on the atherosclerotic state, type of estrogen used, and the coadministration of progestin [10]. Research into the anti-atherosclerotic effect of estrogen is thus needed to establish a better method to deliver estrogen to postmenopausal women. The endogenous estrogen 17β-estradiol (E 2 ) binds to both estrogen receptor (ER) α and β. Activation of ERα and β has been linked with some, but not all, antiatherosclerotic effects of estrogen [11][12][13]. 2-methoxyestradiol (2ME), a metabolite of estradiol with no affinity for estrogen receptors, is a potent inhibitor of cell proliferation, tumor growth, and angiogenesis, and might, at least in part, mediate anti-atherosclerotic effects of estrogen [14][15][16][17]. Abbreviations: E 2 : 17β-estradiol, ER: estrogen receptor, FFA: free fatty acid, 2-ME: 2-methoxyestradiol, NEMOes: New enface method for optimal observation of endothelial surface, TC: total cholesterol, TG: triglyceride.