OBJECTIVE: to evaluate changes in vasomotor endothelium function and elastic properties of the brachial artery in postmenopausal women beginning hormone replacement therapy (HRT) with Climen(R), a 28-day sequential therapy combining estradiol valerate (E2V) 2 mg/day D1-D21 with cyproterone acetate (CPA) 1 mg/day D12-D22, followed by a 7-day treatment-free interval. METHODS: Thirty-one women with natural or surgical menopause were included in an open multicenter study. Before treatment, at the end of the estrogen-only phase of cycle 1, and after the combined phase in cycles 1 and 3, endothelium-dependent vasodilatation (EDVD%) in the brachial artery was measured by the post-ischemia increase of the inner diameter, and pulse wave velocity (PWV) was measured in the same artery by simultaneous continuous wave Doppler and photo-plethysmography. RESULTS: compared to pre-treatment values, the median increase in EDVD was 14.3% after cycle 1 (P=0.0001) and 27.9% after cycle 3 (P=0.0001). CPA did not alter the effect of E2V on EDVD in cycle 1. Median arterial systolic pressure was unchanged, but median diastolic pressure fell from 70 to 67.5 mmHg (P=0.04) after cycle 3. Median PWV was reduced by 0.76 m/s after cycle 3 (relative reduction -9.3%) (P=0.035). There was a significant correlation between PWV and EDVD changes from pre-treatment values at the end of the 3rd cycle. CONCLUSION: treatment of postmenopausal women with E2V/CPA led to an immediate and significant improvement in endothelium-dependent vasodilatation. The estrogen-related vasomotor effect was not suppressed by the progestogen CPA. The WV changes are consistent with slower improvement of arterial compliance in some women. The non-invasive measurement of EDVD and PWV is a convenient method for the evaluation of both mechanical and functional effects of combination HRT on the arterial wall.
OBJECTIVE: to evaluate changes in vasomotor endothelium function and elastic properties of the brachial artery in postmenopausal women beginning hormone replacement therapy (HRT) with Climen(R), a 28-day sequential therapy combining estradiol valerate (E2V) 2 mg/day D1-D21 with cyproterone acetate (CPA) 1 mg/day D12-D22, followed by a 7-day treatment-free interval. METHODS: Thirty-one women with natural or surgical menopause were included in an open multicenter study. Before treatment, at the end of the estrogen-only phase of cycle 1, and after the combined phase in cycles 1 and 3, endothelium-dependent vasodilatation (EDVD%) in the brachial artery was measured by the post-ischemia increase of the inner diameter, and pulse wave velocity (PWV) was measured in the same artery by simultaneous continuous wave Doppler and photo-plethysmography. RESULTS: compared to pre-treatment values, the median increase in EDVD was 14.3% after cycle 1 (P=0.0001) and 27.9% after cycle 3 (P=0.0001). CPA did not alter the effect of E2V on EDVD in cycle 1. Median arterial systolic pressure was unchanged, but median diastolic pressure fell from 70 to 67.5 mmHg (P=0.04) after cycle 3. Median PWV was reduced by 0.76 m/s after cycle 3 (relative reduction -9.3%) (P=0.035). There was a significant correlation between PWV and EDVD changes from pre-treatment values at the end of the 3rd cycle. CONCLUSION: treatment of postmenopausal women with E2V/CPA led to an immediate and significant improvement in endothelium-dependent vasodilatation. The estrogen-related vasomotor effect was not suppressed by the progestogen CPA. The WV changes are consistent with slower improvement of arterial compliance in some women. The non-invasive measurement of EDVD and PWV is a convenient method for the evaluation of both mechanical and functional effects of combination HRT on the arterial wall.
Authors: N Tentolouris; G Christodoulakos; I Lambrinoudaki; E Mandalaki; C Panoulis; C Maridaki; G Creatsas; N Katsilambros Journal: J Endocrinol Invest Date: 2005-04 Impact factor: 4.256