Fw: UT Southwestern News Release April 15, 2003

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ESTROGEN PATCH COMPARED TO PILL MINIMIZES

CARDIOVASCULAR RISK FACTOR IN POSTMENOPAUSAL WOMEN

DALLAS – April 16, 2003 – Administering estrogen replacement therapy via a

skin patch rather than a pill minimizes a cardiovascular risk factor in

postmenopausal women, according to researchers at UT Southwestern Medical

Center at Dallas.

Recent studies have suggested that oral estrogen replacement therapy and

combined hormone replacement therapy resulted in an increase in C-reactive

protein (CRP). CRP is a marker for inflammation in the blood vessels and is

the strongest independent predictor of adverse cardiovascular events in

otherwise healthy postmenopausal women.

In findings reported in today's issue of the Journal of the American College

of Cardiology, researchers at UT Southwestern showed that oral

administration of estrogen therapy " caused a robust increase in CRP, " while

patch-administered doses at nearly twice the strength as those taken orally

had no effect on CRP levels.

" Our research shows that oral estrogen preparations resulted in a twofold

increase in CRP, " said Dr. Wanpen Vongpatanasin, assistant professor of

internal medicine and lead author of the study. " We also found that there

was no change in CRP levels in the same women taking transdermal estrogen

(skin patch). This leads us to believe that the route of administration may

be an important consideration in minimizing the adverse effects of estrogen

replacement therapy on cardiovascular outcomes. "

Vongpatanasin said that when estrogen is given orally, it has to go through

the liver, where it is converted to a less active form of estrogen before it

reaches the bloodstream. When the hormone is given in the form of a patch,

it is directly absorbed into the bloodstream before it goes through the

liver.

" In order to have similar blood levels of estrogen as those with transdermal

estrogen replacement therapy, a much higher dose of oral estrogen is

needed, " she said. " This may contribute to the increased risk for adverse

cardiovascular events in postmenopausal women receiving combined hormone

replacement therapy as shown in large clinical trials. "

A national clinical trial called the Women's Health Initiative was cut short

in 2002 because of a reported heightened risk of heart and other health

problems. In March, additional results from the federally funded Women's

Health Initiative concluded that estrogen pills were an effective treatment

for short-term relief from hot flashes and night sweats, but did not improve

quality of life.

" A significant proportion of women can't stop taking estrogen because of

severe menopausal symptoms, " Vongpatanasin said. " If they have to take

estrogen, our study shows transdermal, not oral, estrogen may be safer. "

In this latest study, UT Southwestern researchers compared the effects of

transdermal estrogen therapy as well as oral estrogen therapy on CRP levels

in 21 postmenopausal women. Participants, in three eight-week cycles, were

given regimens in random order: 100 micrograms of transdermal estrogen and

an oral placebo; 0.625 milligrams of an estrogen pill along with a placebo

patch; and placebo patch and pills.

The researchers also reported a decrease in a protein that plays a role in

reducing inflammation called insulin-like growth factor, or IGF-1.

" Because both CRP and the insulin-like growth factor are produced by the

liver, we believe that the undesirable effects of oral estrogen on the CRP

and IGF-1 are due to changes in metabolism in the liver, " Vongpatanasin

said. " The increase in CRP and the decrease observed in the IGF-1 protein

may be avoided by a transdermal route of administration. "

Other researchers involved in the study were: Debbie Arbique, senior

registered nurse in internal medicine; Dr. Borna Mehrad, assistant professor

of internal medicine; Dr. Meryem Tuncel, an intern in internal medicine, and

Dr. Zhongyun Wang, a postdoctoral researcher in internal medicine. Dr.

Ishwarlal Jialal, formerly of UT Southwestern and currently with the

University of California, , School of Medicine, was the senior author

on the study.

The study was funded by the National Institutes of Health and the U.S.

Public Health Service.

###

This news release is available on our World Wide Web home page at

http://www.utsouthwestern.edu/home_pages/news/

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