Usefulness of baseline lipids and C-reactive protein in women receiving menopausal hormone therapy as predictors of treatment-related coronary events
Paul F Bray, Joseph C Larson, Andrea Z Lacroix, Joann Manson, Marian C Limacher, Jacques E Rossouw, Norman L Lasser, William E Lawson, Marcia L Stefanick, Robert D Langer, Karen L Margolis, Women's Health Initiative Investigators, Elizabeth Nabel, Jacques Rossouw, Shari Ludlam, Linda Pottern, Joan McGowan, Leslie Ford, Nancy Geller, Ross Prentice, Garnet Anderson, Andrea LaCroix, Charles L Kooperberg, Ruth E Patterson, Anne McTiernan, Sally Shumaker, Evan Stein, Steven Cummings, Sylvia Wassertheil-Smoller, Jennifer Hays, JoAnn Manson, Annlouise R Assaf, Lawrence Phillips, Shirley Beresford, Judith Hsia, Rowan Chlebowski, Evelyn Whitlock, Bette Caan, Jane Morley Kotchen, Barbara V Howard, Linda Van Horn, Henry Black, Marcia L Stefanick, Dorothy Lane, Rebecca Jackson, Cora E Lewis, Tamsen Bassford, Jean Wactawski-Wende, John Robbins, F Allan Hubbell, Howard Judd, Robert D Langer, Margery Gass, Marian Limacher, David Curb, Robert Wallace, Judith Ockene, Norman Lasser, Mary Jo O'Sullivan, Karen Margolis, Robert Brunner, Gerardo Heiss, Lewis Kuller, Karen C Johnson, Robert Brzyski, Gloria E Sarto, Denise Bonds, Susan Hendrix, Paul F Bray, Joseph C Larson, Andrea Z Lacroix, Joann Manson, Marian C Limacher, Jacques E Rossouw, Norman L Lasser, William E Lawson, Marcia L Stefanick, Robert D Langer, Karen L Margolis, Women's Health Initiative Investigators, Elizabeth Nabel, Jacques Rossouw, Shari Ludlam, Linda Pottern, Joan McGowan, Leslie Ford, Nancy Geller, Ross Prentice, Garnet Anderson, Andrea LaCroix, Charles L Kooperberg, Ruth E Patterson, Anne McTiernan, Sally Shumaker, Evan Stein, Steven Cummings, Sylvia Wassertheil-Smoller, Jennifer Hays, JoAnn Manson, Annlouise R Assaf, Lawrence Phillips, Shirley Beresford, Judith Hsia, Rowan Chlebowski, Evelyn Whitlock, Bette Caan, Jane Morley Kotchen, Barbara V Howard, Linda Van Horn, Henry Black, Marcia L Stefanick, Dorothy Lane, Rebecca Jackson, Cora E Lewis, Tamsen Bassford, Jean Wactawski-Wende, John Robbins, F Allan Hubbell, Howard Judd, Robert D Langer, Margery Gass, Marian Limacher, David Curb, Robert Wallace, Judith Ockene, Norman Lasser, Mary Jo O'Sullivan, Karen Margolis, Robert Brunner, Gerardo Heiss, Lewis Kuller, Karen C Johnson, Robert Brzyski, Gloria E Sarto, Denise Bonds, Susan Hendrix
Abstract
Blood lipids and high-sensitivity C-reactive protein (hs-CRP) are altered by hormone therapy. The goal of the present study was to determine whether lipids and hs-CRP have predictive value for hormone therapy benefit or risk for coronary heart disease events in postmenopausal women without previous cardiovascular disease. A nested case-control study was performed in the Women's Health Initiative hormone trials. Baseline lipids and hs-CRP were obtained from 271 incident patients with coronary heart disease (cases) and 707 controls. In a combined trial analysis, favorable lipid status at baseline tended to predict better coronary heart disease outcomes when using conjugated equine estrogen (CEE) with or without medroxyprogesterone acetate (MPA). Women with a low-density lipoprotein (LDL)/high-density lipoprotein (HDL) cholesterol ratio <2.5 had no increase in risk of coronary heart disease when using CEE with or without MPA (odds ratio 0.60, 95% confidence interval 0.34 to 1.06), whereas women with an LDL/HDL cholesterol ratio > or =2.5 had increased risk of coronary heart disease (odds ratio 1.73, 95% confidence interval 1.18 to 2.53, p for interaction = 0.02). Low hs-CRP added marginally to the value of LDL/HDL ratio <2.5 when predicting coronary heart disease benefit on hormone therapy. In conclusion, postmenopausal women with undesirable lipid levels had excess coronary heart disease risk when using CEE with or without MPA. However, women with favorable lipid levels, especially LDL/HDL cholesterol ratio <2.5, did not have increased risk of coronary heart disease with CEE with or without MPA irrespective of hs-CRP.
Trial registration: ClinicalTrials.gov NCT00000611.
Source: PubMed