Relation of Hormone-Replacement Therapy to Measures of Plasma Fibrinolytic Activity

Eyal Shahar, Aaron R. Folsom, Veikko V. Salomaa, Valarie L. Stinson, Paul G. McGovern, Tomoko Shimakawa, Lloyd E. Chambless, Kenneth K. Wu

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Background: The mechanisms by which replacement hormones may reduce the risk of coronary heart disease are not fully understood. Of specific interest is a potential effect of replacement hormones on plasma fibrinolytic activity, a putative determinant of thrombotic events. Methods and Results: We investigated the relation of current use of replacement hormones to three measures of plasma fibrinolytic activity: tissue-type plasminogen activator (TPA) antigen, plasminogen activator inhibitor-1 (PAI-1) antigen, and D-dimer. The sample was composed of 288 women, free of clinical cardiovascular disease, who were selected for a case-control study of atherosclerosis: 142 women with ultrasonographic evidence of carotid intimal-medial thickening (cases) and 146 control subjects. Twenty percent (59 women) reported current use of replacement hormones. TPA antigen and PAI-1 antigen were highly correlated with each other (r=.67), whereas D-dimer correlated only weakly with TPA or PAI-1. Compared with nonusers, current users of replacement hormones had lower mean levels of TPA and PAI-1 antigens, suggesting enhanced fibrinolytic potential. In the entire sample, the multivariate-adjusted geometric mean values of TPA antigen were 6.3 and 7.3 ng/mL among current users and nonusers, respectively (P=.01); the corresponding values for PAI-1 antigen were 6.1 and 7.5 ng/mL (P=.13). These results were generally consistent for both atherosclerosis cases and their control subjects. D-dimer levels were lower in current hormone users than in nonusers, but the difference was not statistically significant (P>.15) in any of the analyses. Conclusions: The use of replacement hormones appears to be associated with enhancement of endogenous fibrinolytic potential. Enhanced plasma fibrinolytic activity among hormone users may explain, in part, the inverse association between hormone replacement therapy and coronary heart disease.

Original languageEnglish (US)
Pages (from-to)1970-1975
Number of pages6
JournalCirculation
Volume93
Issue number11
StatePublished - Jun 1 1996
Externally publishedYes

Fingerprint

Hormone Replacement Therapy
Hormones
Plasminogen Activator Inhibitor 1
Plasminogen Activators
Antigens
Coronary Disease
Atherosclerosis
Tunica Intima
Tissue Plasminogen Activator
Case-Control Studies
Cardiovascular Diseases

Keywords

  • Atherosclerosis
  • Fibrinolysis
  • Hormones

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Shahar, E., Folsom, A. R., Salomaa, V. V., Stinson, V. L., McGovern, P. G., Shimakawa, T., ... Wu, K. K. (1996). Relation of Hormone-Replacement Therapy to Measures of Plasma Fibrinolytic Activity. Circulation, 93(11), 1970-1975.

Relation of Hormone-Replacement Therapy to Measures of Plasma Fibrinolytic Activity. / Shahar, Eyal; Folsom, Aaron R.; Salomaa, Veikko V.; Stinson, Valarie L.; McGovern, Paul G.; Shimakawa, Tomoko; Chambless, Lloyd E.; Wu, Kenneth K.

In: Circulation, Vol. 93, No. 11, 01.06.1996, p. 1970-1975.

Research output: Contribution to journalArticle

Shahar, E, Folsom, AR, Salomaa, VV, Stinson, VL, McGovern, PG, Shimakawa, T, Chambless, LE & Wu, KK 1996, 'Relation of Hormone-Replacement Therapy to Measures of Plasma Fibrinolytic Activity', Circulation, vol. 93, no. 11, pp. 1970-1975.
Shahar E, Folsom AR, Salomaa VV, Stinson VL, McGovern PG, Shimakawa T et al. Relation of Hormone-Replacement Therapy to Measures of Plasma Fibrinolytic Activity. Circulation. 1996 Jun 1;93(11):1970-1975.
Shahar, Eyal ; Folsom, Aaron R. ; Salomaa, Veikko V. ; Stinson, Valarie L. ; McGovern, Paul G. ; Shimakawa, Tomoko ; Chambless, Lloyd E. ; Wu, Kenneth K. / Relation of Hormone-Replacement Therapy to Measures of Plasma Fibrinolytic Activity. In: Circulation. 1996 ; Vol. 93, No. 11. pp. 1970-1975.
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AU - Stinson, Valarie L.

AU - McGovern, Paul G.

AU - Shimakawa, Tomoko

AU - Chambless, Lloyd E.

AU - Wu, Kenneth K.

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N2 - Background: The mechanisms by which replacement hormones may reduce the risk of coronary heart disease are not fully understood. Of specific interest is a potential effect of replacement hormones on plasma fibrinolytic activity, a putative determinant of thrombotic events. Methods and Results: We investigated the relation of current use of replacement hormones to three measures of plasma fibrinolytic activity: tissue-type plasminogen activator (TPA) antigen, plasminogen activator inhibitor-1 (PAI-1) antigen, and D-dimer. The sample was composed of 288 women, free of clinical cardiovascular disease, who were selected for a case-control study of atherosclerosis: 142 women with ultrasonographic evidence of carotid intimal-medial thickening (cases) and 146 control subjects. Twenty percent (59 women) reported current use of replacement hormones. TPA antigen and PAI-1 antigen were highly correlated with each other (r=.67), whereas D-dimer correlated only weakly with TPA or PAI-1. Compared with nonusers, current users of replacement hormones had lower mean levels of TPA and PAI-1 antigens, suggesting enhanced fibrinolytic potential. In the entire sample, the multivariate-adjusted geometric mean values of TPA antigen were 6.3 and 7.3 ng/mL among current users and nonusers, respectively (P=.01); the corresponding values for PAI-1 antigen were 6.1 and 7.5 ng/mL (P=.13). These results were generally consistent for both atherosclerosis cases and their control subjects. D-dimer levels were lower in current hormone users than in nonusers, but the difference was not statistically significant (P>.15) in any of the analyses. Conclusions: The use of replacement hormones appears to be associated with enhancement of endogenous fibrinolytic potential. Enhanced plasma fibrinolytic activity among hormone users may explain, in part, the inverse association between hormone replacement therapy and coronary heart disease.

AB - Background: The mechanisms by which replacement hormones may reduce the risk of coronary heart disease are not fully understood. Of specific interest is a potential effect of replacement hormones on plasma fibrinolytic activity, a putative determinant of thrombotic events. Methods and Results: We investigated the relation of current use of replacement hormones to three measures of plasma fibrinolytic activity: tissue-type plasminogen activator (TPA) antigen, plasminogen activator inhibitor-1 (PAI-1) antigen, and D-dimer. The sample was composed of 288 women, free of clinical cardiovascular disease, who were selected for a case-control study of atherosclerosis: 142 women with ultrasonographic evidence of carotid intimal-medial thickening (cases) and 146 control subjects. Twenty percent (59 women) reported current use of replacement hormones. TPA antigen and PAI-1 antigen were highly correlated with each other (r=.67), whereas D-dimer correlated only weakly with TPA or PAI-1. Compared with nonusers, current users of replacement hormones had lower mean levels of TPA and PAI-1 antigens, suggesting enhanced fibrinolytic potential. In the entire sample, the multivariate-adjusted geometric mean values of TPA antigen were 6.3 and 7.3 ng/mL among current users and nonusers, respectively (P=.01); the corresponding values for PAI-1 antigen were 6.1 and 7.5 ng/mL (P=.13). These results were generally consistent for both atherosclerosis cases and their control subjects. D-dimer levels were lower in current hormone users than in nonusers, but the difference was not statistically significant (P>.15) in any of the analyses. Conclusions: The use of replacement hormones appears to be associated with enhancement of endogenous fibrinolytic potential. Enhanced plasma fibrinolytic activity among hormone users may explain, in part, the inverse association between hormone replacement therapy and coronary heart disease.

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