Key result
Oral hormone replacement therapy with CEE and MPA increased SHBG and decreased PAI-1, but SHBG and CBG could not be used as predictors of increased cardiovascular risk.
Why the study?
Does oral hormone replacement therapy alter hemostatic factors and steroid sensitive proteins in postmenopausal women with coronary heart disease?
RCT (n=28)
Does oral hormone replacement therapy alter hemostatic factors and steroid sensitive proteins in postmenopausal women with coronary heart disease?
SHBG and CBG are not useful as predictors of increased cardiovascular risk during postmenopausal oral hormone replacement therapy in women with coronary heart disease.
Answers are grounded in this paper and cite their sources.
SHBG and CBG lack value as CV risk predictors during oral HRT; challenges their clinical utility and leaves open need for alternative biomarkers in women with CHD.
OBJECTIVE: To study a possible use of sex hormone-binding globulin (SHBG) and corticosteroid-binding globulin (CBG) as markers for changes in hemostatic factors during oral postmenopausal hormone replacement therapy (HRT). METHODS: Twenty-eight postmenopausal women were treated with oral conjugated equine estrogens+oral medroxyprogesterone acetate (CEE + MPA, n = 15) or with placebo (n = 13). Serum SHBG, CBG, testosterone, cortisol and plasma coagulation factors, coagulation inhibitors and markers of coagulation activation were measured before and after 6 and 12 months of treatment. RESULTS: Pretreatment plasminogen activator inhibitor 1 (PAI-1) levels correlated negatively to SHBG and antithrombin III (AT III) negatively to total and free cortisol. In the CEE + MPA group, CBG, SHBG and Factor VII increased, and PAI-1, AT III and free testosterone decreased during treatment. No significant changes were found in plasma von Willebrand factor antigen, thrombin-antithrombin complex, fibrin D-dimer and fibrinogen. A significant, negative correlation was found between changes in SHBG and PAI-1. No changes were found in the placebo group. CONCLUSION: The only correlation found between changes in "steroid sensitive" proteins and hemostatic factors was between increased SHBG and a possibly beneficial effect of estrogens, i.e. decreased PAI-1 values. SHBG or CBG could not be used as predictors of increased cardiovascular risk during postmenopausal oral HRT.
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Pripp et al. (2004) conducted an RCT in coronary heart disease (n=28). oral conjugated equine estrogens + oral medroxyprogesterone acetate (CEE + MPA) vs. placebo was evaluated on changes in hemostatic factors, SHBG, and CBG. Oral hormone replacement therapy with CEE and MPA increased SHBG and decreased PAI-1, but SHBG and CBG could not be used as predictors of increased cardiovascular risk.
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