Copyright © 2000 by the European Society of Cardiology.
Cell adhesion molecules in relation to simvastatin and hormone replacement therapy in coronary artery disease
a 2nd Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
b Department of Immunology, Onassis Cardiac Surgery Center, Athens, Greece
revised August 12, 1999; accepted August 13, 1999
Abstract
Aims To assess the effect of simvastatin, hormone replacement therapy and their combination on soluble cell adhesion molecules and plasma lipids, in hypercholesterolaemic post-menopausal women with coronary artery disease.
Methods We studied 16 post-menopausal women with coronary artery disease and hypercholesterolaemia (total cholesterol >200mg.dl–1and LDL cholesterol >130mg.dl–1). We compared simvastatin (20mg daily) with hormone replacement therapy (0·625mg conjugated oestrogen and 2·5mg medroxyprogesterone acetate daily) and their combination, in a randomized, crossover, placebo controlled study. Each treatment period was 8 weeks long with a 4 week washout interval between treatments. Circulating cell adhesion molecules and plasma lipids were evaluated at the end of each treatment period.
Results All three active treatments—simvastatin, hormone replacement therapy and the combination therapy—significantly reduced total and LDL cholesterol, compared to placebo (P<0·001). Only hormone replacement therapy, alone and in combination with simvastatin, significantly decreased lipoprotein(a) when compared to placebo (P<0·05), whereas simvastatin had no significant effect. Likewise, hormone replacement therapy and the combination therapy significantly reduced the intercellular adhesion molecule (ICAM-1) plasma levels (P=0·03 and P=0·02, respectively), while simvastatin, which was superior to hormone replacement therapy in lowering total and LDL cholesterol, did not modify ICAM-1 levels; the combination therapy was not more effective than hormone replacement therapy alone in ICAM-1 reduction. Neither the effect, on any treatment when compared to placebo, of VCAM-1 nor E-selectin levels differed significantly.
Conclusions Hormone replacement therapy may limit the inflammatory response to injury by modulating the expression of cell adhesion molecules from the endothelial cells, possibly in association with lipoprotein (a) reduction.
Key Words: Statins, hormone replacement therapy, cell adhesion molecules, coronary artery disease, lipids
f1 Correspondence: E. Sbarouni, Onassis Cardiac Surgery Center, 2nd Department of Cardiology, 356 Sygrou Ave, 17674 Athens, Greece.
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