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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2002;22:1459.)
© 2002 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Effects of Continuous Combined Hormone Replacement Therapy on Inflammation in Hypertensive and/or Overweight Postmenopausal Women

Kwang Kon Koh; Jeong Yeal Ahn; Dong Kyu Jin; Byung-Koo Yoon; Hyung Sik Kim; Dae Sung Kim; Mi-Seung Shin; Ji Won Son; In Suck Choi; Eak Kyun Shin

From the Departments of Cardiology (K.K.K., K.K.J., M.-S. S., J.W.S., I.S.C., E.K.S.), Clinical Pathology (J.Y.A.), Obstetrics and Gynecology (B.K.Y.) (Samsung Medical Center, Sungkyunkwan University), Radiology (H.S.K.), and Preventive Medicine (Biostatistics) (D.S.K.), Gachon Medical School, Incheon, Korea

Address correspondence to Kwang Kon Koh, MD, FACC, FAHA, Professor of Medicine, Director, Vascular Medicine and Atherosclerosis Unit, Division of Cardiology, Gil Heart Center, Gachon Medical School, 1198 Kuwol-dong, Namdong-gu, Incheon, Korea 405-760. E-mail kwangk{at}ghil.com

Objective— We observed that estrogen did not show cardioprotective benefits in type 2 diabetic postmenopausal women. We hypothesized that hypertensive and/or overweight women may be less likely to realize cardiovascular benefits from estrogen.

Methods and Results— We administered micronized progesterone (MP) 100 mg or medroxyprogesterone acetate (MPA) 2.5 mg with conjugated equine estrogen (CEE) 0.625 mg daily during 2 months to 35 hypertensive and/or overweight postmenopausal women with a randomized, double-blind, crossover design. With significant changes of lipoproteins, CEE+MP or MPA significantly improved flow-mediated dilation and reduced plasma E-selectin, intercellular adhesion molecule type-1, monocyte chemoattractant protein-1, and tumor necrosis factor- levels (P<0.001, P<0.001, P=0.021, P<0.001, and P<0.001 by ANOVA, respectively), but not C-reactive protein and fibrinogen levels. Of note, there were no significant differences between each therapy regarding these effects. However, the magnitude of improvement of flow-mediated dilation in these women was less than in healthy postmenopausal women and more than in diabetic postmenopausal women reported by our previous studies. The effects of CEE+MP or MPA on inflammatory markers were comparable to healthy postmenopausal women, but not comparable to diabetic postmenopausal women.

Conclusions— Estrogen combined with synthetic progestin significantly improved flow-mediated brachial artery dilator response and reduced inflammation markers in hypertensive and/or overweight women, comparable to estrogen combined with natural progesterone.

Key Words: synthetic progestin • inflammation • hypertension • overweight • menopause

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