(Circulation. 1999;100:713-716.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Hormone Replacement Therapy and Increased Plasma Concentration of C-Reactive Protein
From the Division of Preventive Medicine (P.M.R., C.H.H., J.E.B., J.E.M.) and Cardiovascular Diseases (P.M.R.), Brigham and Women's Hospital; the Department of Ambulatory Care and Prevention (J.E.B., C.H.H.); and the Childrens' Hospital Medical Center (N.R.), Harvard Medical School, Boston, Mass.
Correspondence to Paul M. Ridker, MD, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. E-mail pmridker{at}bics.bwh.harvard.edu
Background—It has been hypothesized that postmenopausal hormone replacement therapy (HRT) may increase levels of C-reactive protein (CRP), a marker of inflammation associated with increased risk of future cardiovascular events. However, data evaluating this hypothesis are sparse and limited to older women.
Methods and Results—CRP levels were evaluated in a cross-sectional survey of 493 healthy postmenopausal women; mean age was 51 years. Overall, median CRP levels were 2 times higher among women taking HRT than among women not taking HRT (0.27 versus 0.14 mg/dL; P=0.001). This difference was present in all subgroups evaluated, including those with no history of hypertension, hyperlipidemia, obesity, diabetes, or cigarette consumption or a family history of premature coronary artery disease (all P< 0.01). Compared with nonusers of HRT, median CRP levels were higher among women using estrogen alone (P=0.003) and women using estrogen plus progesterone (P=0.03); however, there was no significant difference in CRP levels between users of different HRT preparations. In multivariate analysis, the relationship between HRT use and CRP remained significant after control for body mass index, age, diabetes, hypertension, hyperlipidemia, alcohol use, and cigarette consumption (P=0.001).
Conclusions—In this cross-sectional survey, CRP levels were increased among apparently healthy postmenopausal women taking HRT. The potential impact of HRT on inflammatory parameters should be investigated in ongoing clinical trials.
Key Words: inflammation • hormones • C-reactive protein • risk factors
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R. P. Tracy Is Visceral Adiposity the "Enemy Within"? Arterioscler. Thromb. Vasc. Biol., June 1, 2001; 21(6): 881 - 883. [Full Text] [PDF]
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L. K. Heilbronn, M. Noakes, and P. M. Clifton Energy Restriction and Weight Loss on Very-Low-Fat Diets Reduce C-Reactive Protein Concentrations in Obese, Healthy Women Arterioscler. Thromb. Vasc. Biol., June 1, 2001; 21(6): 968 - 970. [Abstract] [Full Text] [PDF]
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E. Barinas-Mitchell, M. Cushman, E. N. Meilahn, R. P. Tracy, and L. H. Kuller Serum Levels of C-reactive Protein Are Associated with Obesity, Weight Gain, and Hormone Replacement Therapy in Healthy Postmenopausal Women Am. J. Epidemiol., June 1, 2001; 153(11): 1094 - 1101. [Abstract] [Full Text] [PDF]
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A. M. Sharma, V. Homuth, and F. C. Luft Hormone replacement therapy and blood pressure in normotensive and hypertensive women Nephrol. Dial. Transplant., May 1, 2001; 16(5): 888 - 890. [Full Text] [PDF]
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P. M. Ridker High-Sensitivity C-Reactive Protein : Potential Adjunct for Global Risk Assessment in the Primary Prevention of Cardiovascular Disease Circulation, April 3, 2001; 103(13): 1813 - 1818. [Abstract] [Full Text] [PDF]
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N. Rifai and P. M. Ridker High-Sensitivity C-Reactive Protein: A Novel and Promising Marker of Coronary Heart Disease Clin. Chem., March 1, 2001; 47(3): 403 - 411. [Abstract] [Full Text] [PDF]
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P. Angerer, S. Stork, W. Kothny, P. Schmitt, and C. von Schacky Effect of Oral Postmenopausal Hormone Replacement on Progression of Atherosclerosis : A Randomized, Controlled Trial Arterioscler. Thromb. Vasc. Biol., February 1, 2001; 21(2): 262 - 268. [Abstract] [Full Text] [PDF]
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M. Visser, L. M. Bouter, G. M. McQuillan, M. H. Wener, and T. B. Harris Low-Grade Systemic Inflammation in Overweight Children Pediatrics, January 1, 2001; 107(1): 13e - 13. [Abstract] [Full Text]
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D. Zanger, B. K. Yang, J. Ardans, M. A. Waclawiw, G. Csako, L. M. Wahl, and R. O. Cannon III Divergent effects of hormone therapy on serum markers of inflammation in postmenopausal women with coronary artery disease on appropriate medical management J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1797 - 1802. [Abstract] [Full Text] [PDF]
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X. Garcia-Moll, E. Zouridakis, D. Cole, and J.C. Kaski C-reactive protein in patients with chronic stable angina: differences in baseline serum concentration between women and men Eur. Heart J., October 1, 2000; 21(19): 1598 - 1606. [Abstract] [PDF]
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N. Sattar, N. G. Forouhi, R. A. Wild, M. Cushman, P. A. Sakkinen, R. P. Tracy, C. Legault, E. Barrett-Connor, M. L. Stefanick, C. M. Kessler, et al. C-Reactive Protein and Hormone Replacement Therapy Response Circulation, September 26, 2000; 102 (13): e96 - e97. [Full Text] [PDF]
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D. M. Herrington, D. M. Reboussin, K. B. Brosnihan, P. C. Sharp, S. A. Shumaker, T. E. Snyder, C. D. Furberg, G. J. Kowalchuk, T. D. Stuckey, W. J. Rogers, et al. Effects of Estrogen Replacement on the Progression of Coronary-Artery Atherosclerosis N. Engl. J. Med., August 24, 2000; 343(8): 522 - 529. [Abstract] [Full Text] [PDF]
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R. F. Redberg, N. Rifai, L. Gee, and P. M. Ridker Lack of association of C-reactive protein and coronary calcium by electron beam computed tomography in postmenopausal women: implications for coronary artery disease screening J. Am. Coll. Cardiol., July 1, 2000; 36(1): 39 - 43. [Abstract] [Full Text] [PDF]
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 Postmenopausal estrogen replacement therapy and increased rates of cholecystectomy and appendectomy Can. Med. Assoc. J., May 1, 2000; 162(10): 1421 - 1424.
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W. L. Roberts, R. Sedrick, L. Moulton, A. Spencer, and N. Rifai Evaluation of Four Automated High-Sensitivity C-Reactive Protein Methods: Implications for Clinical and Epidemiological Applications Clin. Chem., April 1, 2000; 46(4): 461 - 468. [Abstract] [Full Text] [PDF]
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 Estrogen May Increase Vascular Inflammation Journal Watch Women's Health, October 1, 1999; 1999(1001): 13 - 13. [Full Text]
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 Does Hormone Replacement Therapy Increase Vascular Inflammation? Journal Watch (General), September 3, 1999; 1999(903): 1 - 1. [Full Text]
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A. Wakatsuki, Y. Okatani, N. Ikenoue, and T. Fukaya Effect of Medroxyprogesterone Acetate on Vascular Inflammatory Markers in Postmenopausal Women Receiving Estrogen Circulation, March 26, 2002; 105(12): 1436 - 1439. [Abstract] [Full Text] [PDF]
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D. M. Herrington, T. D. Howard, K. B. Brosnihan, D. P. McDonnell, X. Li, G. A. Hawkins, D. M. Reboussin, J. Xu, S. L. Zheng, D. A. Meyers, et al. Common Estrogen Receptor Polymorphism Augments Effects of Hormone Replacement Therapy on E-Selectin but Not C-Reactive Protein Circulation, April 23, 2002; 105(16): 1879 - 1882. [Abstract] [Full Text] [PDF]
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