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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2003;23:1948.)
© 2003 American Heart Association, Inc.

Letter to the Editor

Different Effects of Oral and Transdermal Estrogen Replacement Therapy on Matrix Metalloproteinase and Their Inhibitor in Postmenopausal Women

Akihiko Wakatsuki; Nobuo Ikenoue; Koichi Shinohara; Kazushi Watanabe; Takao Fukaya

Department of Obstetrics and Gynecology Kochi Medical School, Kochi, Japan

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

The Heart and Estrogen/Progestin Replacement Study¹ and the Women’s Health Initiative² showed no benefit of oral hormone replacement therapy (HRT) on the risk of coronary heart disease (CHD). Oral estrogen replacement therapy (ERT) has been reported to elevate plasma concentrations of C-reactive protein (CRP), an independent risk factor for cardiovascular disease in healthy postmenopausal women.³ Macrophages in human atherosclerotic plaques produce matrix metalloproteinase (MMP) that degrades collagen and elastin, the major components of the extracellular matrix in the fibrin cap, and predispose it to rupture with thrombus formation. Although little is known about the effect of HRT on MMP, one clinical study has demonstrated that oral ERT increases plasma concentrations of MMP in women with CHD.⁴ It is likely, therefore, that raised levels of CRP and MMP induced by oral ERT may account in part for the increased number of early cardiovascular events observed in the recent trials. In contrast to oral ERT, plasma CRP concentration is reduced⁵ or not influenced⁶ by transdermal ERT. Accordingly, neutral effect of transdermal ERT on CRP might possibly be associated with a safer profile on early CHD risk. However, the effect of transdermal ERT on MMP has not been evaluated. In the present study, to investigate whether transdermal ERT can eliminate oral estrogen’s adverse effects, we measured plasma concentrations of MMP and their inhibitors such as tissue inhibitor of MMP (TIMP) in postmenopausal women treated with estrogen orally or transdermally.

Subjects in the oral estrogen group (n=20) received 0.625 mg oral . . . [Full Text of this Article]

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