Objective
To determine the effects of estrogen therapy (ET) on carotid artery inflammation when initiated early and late relative to surgical menopause.
Methods and Results
Female cynomolgus macaques consuming atherogenic diets were ovariectomized and randomized to control or oral estradiol (E2, human equivalent dose of 1 mg/d micronized E2) initiated at 1 month (Early menopause, n=24) or 54 months, (Late menopause, n=40) post-ovariectomy. Treatment period was 8 months. Carotid artery expression of markers of monocyte/macrophages (CD68, CD163), dendritic cells (CD83), NK cells (NCAM-1), and IFN-γ was significantly lower in the E2-treated animals in the early but not late menopause group (p<0.05). In contrast, carotid artery transcripts for T cell markers (CD3, CD4, CD8, and CD25), interleukin (IL)-10, type I collagen, MCP-1, MMP-9, and TNF-α were lower in E2-treated monkeys regardless of menopausal stage (p<0.05).
Conclusions
ET initiated soon after menopause inhibited macrophage accumulation in the carotid artery, an effect not observed when E2 was administered after several years of estrogen deficiency. No evidence for pro-inflammatory effects of late ET was observed. The results provide support for the timing hypothesis of postmenopausal ET with implications for interpretation of outcomes in the Women’s Health Initiative.