EFECTOS DE LA TERAPIA HORMONAL SOBRE LA CONCENTRACIÓN DE PROTEINA C REACTIVA. Revisión

Menopause is associated with increased risk of cardiovascular disease (CVD). Both primary and secondary prevention controlled studies have failed to demonstrate a reduction of CVD despite beneficial effects on lipoprotein metabolism and endothelial function suggesting that other factors may contribute to this complication. Inflammatory activity has been involved in atherogenesis and arteriosclerosis progression. Hormonal therapy (HT) effects on inflammation markers depend on estrogen type, doses and route of administration. Several studies show that conventional combined oral HT is associated with an increased inflammatory response, which is expressed by an increased C reactive protein (CRP) concentration while transdermal therapy has a neutral effect. This abnormality is attenuated by using lower doses and it is amplified in diabetic women, which show a higher incidence of cardiovascular events. Tibolone has controversial effects on PCR; some studies report an increase in PCR levels while others report no effects. The selective estrogen receptor modulators such as tamoxifen, raloxifene and droloxifene cause a significant reduction of PCR levels. The route of estrogen administration should be considered at prescribing HT, particularly in women at high risk of CVD. Future long-term studies using different doses and routes of estrogen administration are required to make clear the real impact of estrogen therapy on cardiovascular disease.