Oral postmenopausal hormone therapy, C-reactive protein, and cardiovascular outcomes

Abstract

Objectives-This study examines C-reactive protein (CRP) levels predict cardiovascular events (CVE) among hormone therapy (HT) users and non-users.Background-CRP levels are higher in women who use oral HT than in non-users; however, whether the same CRP cutpoints determine increased cardiovascular risk remains unanswered.

Platelet reactivity and thrombogenicity in postmenopausal women

“…37 In a subanalysis of the Women's Health Study, Kurtz et al 38 showed that CRP had a linear relationship in predicting cardiovascular events among both HT users and nonusers; in particular, CRP levels of 3 mg/L or higher were associated with increased cardiovascular risk in both HT users and nonusers. A prospective study of healthy postmenopausal women concluded that baseline CRP concentration is an independent risk factor for cardiovascular diseases.…”

Sex Hormones and Vascular Function

“…(Vongpatanasin et al, 2003;Mosca et al, 2004) Data from the WHI and the Women's Health S t u d y h a v e d e m o n s t r a t e d t h a t C R P p r e d i c t s C V D r i s k i n p o s t -m e n o p a u s a l w o m e n independent of HRT. (Kurtz et al, 2011) HRT use had less predictive value than CRP levels in these studies. Thus, the clinical significance of hormone-related changes in circulating CRP levels remains uncertain.…”

Hold, raise, or fold

“…13 Their findings are provocative, though. As with many studies, these results generate more questions than answers: should risk stratification for CRP differ for women taking transdermal versus oral estrogen therapy?…”

“…8 According to the conclusions by Kurtz et al, 13 women on hormone therapy have the same CVD risk at the same CRP level as women not taking hormone therapy. However, had those women not initiated oral estrogen, would their CRP level be half of that measured, and possibly, would their CVD risk also be half?…”

“…13 Hormone therapy users with a CRP of 3 mg/L or greater had an almost twofold greater risk for combined CVD events; nonusers demonstrated an almost identical risk. 13 Their final conclusion, though, is somewhat perplexing given that they also present data suggesting that women using hormone therapy had an approximately 50% lower risk of cardiovascular events at similar levels of CRP compared with nonusers. In some ways, this finding seems more intuitive if the increase in CRP level after hormone therapy is reflective of a hepatic synthetic response to oral estrogen rather than stimulation of an inflammatory process.…”