Fibrinolysis and lipoprotein(a) in women with coronary artery disease. Influence of hormone replacement therapy

Background and Objectives. The incidence of coronary artery disease (GAD) i s higher in post-menopausal than in pre-menopausal women. Epidemiological s tudies suggest that hormone replacement therapy (HRT) decreases the risk of cardiovascular disease in post-menopausal women. HRT could modify the card iovascular risk via several mechanisms, including modifications in the fibr inolytic system and lipoprotein (a) levels. Our study was aimed at investig ating some of these modifications. Design and Methods. In the cross-sectional part of the study we evaluated s everal components of the fibrinolytic system, coagulation inhibitors and li pid profile in premenopausal (n=15) and post-menopausal women (n=64) with C AD and compared these parameters with those of healthy pre-menopausal (n=31 ) and post-menopausal women (n=88). The prospective part of the study analy zed the effect of HRT with transdermal estrogen with or without progestogen in post-menopausal women with CAD. Results. Pre- and postmenopausal women with CAD showed significant lower fi brinolytic activity and higher plasminogen activator inhibitor type 1 (PAI- 1) levels than their control groups. Lp(a) levels were higher in pre-menopa usal women with CAD than in healthy pre-menopausal women. In post-menopausa l women with CAD, HRT induced a significant decrease in PAI-1 and Lp(a) lev els. No significant differences were observed in any parameter studied betw een the groups treated with transdermal estrogen with and without progestog en. Interpretation and Conclusions. CAD is associated with a decrease in fibrin olytic activity, possibly due to an increase in PAI-1 levels. An increase i n fibrinolytic activity and a decrease in PAI-1 and Lp(a) levels were obser ved in CAD women receiving transdermal HRT and these changes may have a fav orable impact on the risk of new cardiovascular events in post-menopausal C AD women. (C) 2001, Ferrata Storti Foundation.