Homocysteine in Postmenopausal Women and the Importance of Hormone Replacement Therapy
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Velja Mijatovic
Abstract
Homocysteine (Hcy) has been shown to damage the vascular endothelial cells, contributing to atherothrombosis. The increase in plasma Hcy levels with natural menopause suggests a close relationship between Hcy metabolism and estrogen status and proposes one of the mechanisms through which menopause unfavorably affects cardiovascular disease risk in women. In addition to the prevention of osteoporosis, hormone replacement therapy (HRT) lowers Hcy levels in postmenopausal women. The first report by van der Mooren et al., demonstrated in an uncontrolled study a significant reduction (11%) in fasting serum Hcy level after 6 months of treatment with sequentially combined estradiol-dydrogesterone therapy in 21 healthy postmenopausal women. This effect was particularly evident in women with initially elevated baseline serum Hcy concentrations. Similar results were found in other studies in which women were treated with various transdermal as well as oral HRT regimens, although two studies could not confirm these findings. All these studies were uncontrolled, and three of them consisted of a relatively small number of participants. Therefore, they remained inconclusive. Three randomized controlled trials on HRT and Hcy were published to date, confirming that postmenopausal HRT reduces circulating levels of Hcy. Current and recent HRT use is associated with a slight increased risk of breast cancer. As a result of this, research has centered on finding compounds that can prevent the consequences of estrogen deficiency, without the potential risk of HRT. Raloxifene, referred to as a Selective Estrogen Receptor Modulator (SERM), has the potential as a viable alternative to HRT. Recently, two randomized controlled trials demonstrated that raloxifene lowers plasma Hcy levels in postmenopausal women, similar to the reduction obtained with HRT. Little is known about the mechanisms underlying the HRT-associated lowering of plasma Hcy. Proposed mechanisms relate to an increase in kidney methionine synthase activity or may be related to the transamination of methionine. We conclude that HRT decreases plasma Hcy levels in postmenopausal women and that the strongest reductions can be achieved in women with the highest concentrations.
Copyright © 2001 by Walter de Gruyter GmbH & Co. KG
Articles in the same Issue
- Historical Aspects and Perspectives in Homocysteine Research
- The Importance of Hyperhomocysteinemia as a Risk Factor for Diseases: An Overview
- Pre-analytical Conditions Affecting the Determination of the Plasma Homocysteine Concentration
- Total Plasma Homocysteine and Related Amino Acids in End-Stage Renal Disease (ESRD) Patients Measured by Gas Chromatography-Mass Spectrometry – Comparison with the Abbott IMx Homocysteine Assay and the HPLC Method
- Is Hyperhomocysteinemia due to the Oxidative Depletion of Folate rather than to Insufficient Dietary Intake?
- Hyperhomocysteinemia in Advanced Age
- Genetic Defects as Important Factors for Moderate Hyperhomocysteinemia
- Heterogeneity of the Association between Plasma Homocysteine and Atherothrombotic Disease: Insights from Studies of Vascular Structure and Function
- Hyperhomocysteinemia as a Risk Factor for Venous Thrombosis
- Hyperhomocysteinaemia in Patients with Peripheral Arterial Occlusive Disease
- Homocysteine, Vascular Dementia and Alzheimer's Disease
- Homocysteine in Cerebrovascular Disease: an Independent Risk Factor for Subcortical Vascular Encephalopathy
- Vascular Dysfunction in Hyperhomocyst(e)inemia. Implications for Atherothrombotic Disease
- Hyperhomocysteinemia in Chronic Renal Failure Patients: Relation to Nutritional Status and Cardiovascular Disease
- Homocysteine, Cystathionine, Methylmalonic Acid and B-Vitamins in Patients with Renal Disease
- Hyperhomocysteinemia Is Related to Residual Glomerular Filtration and Folate, but not to Methylenetetrahydrofolate-Reductase and Methionine Synthase Polymorphisms, in Supplemented End-Stage Renal Disease Patients Undergoing Hemodialysis
- Effect of Treatment of Hypothyroidism on the Plasma Concentrations of Neuroactive Steroids and Homocysteine
- Hyperhomocysteinaemia and Human Reproduction
- Homocysteine in Postmenopausal Women and the Importance of Hormone Replacement Therapy
- Does a Single Vitamin B-Supplementation Induce Functional Vitamin B-Deficiency?
- IFCC News – July 2001
Articles in the same Issue
- Historical Aspects and Perspectives in Homocysteine Research
- The Importance of Hyperhomocysteinemia as a Risk Factor for Diseases: An Overview
- Pre-analytical Conditions Affecting the Determination of the Plasma Homocysteine Concentration
- Total Plasma Homocysteine and Related Amino Acids in End-Stage Renal Disease (ESRD) Patients Measured by Gas Chromatography-Mass Spectrometry – Comparison with the Abbott IMx Homocysteine Assay and the HPLC Method
- Is Hyperhomocysteinemia due to the Oxidative Depletion of Folate rather than to Insufficient Dietary Intake?
- Hyperhomocysteinemia in Advanced Age
- Genetic Defects as Important Factors for Moderate Hyperhomocysteinemia
- Heterogeneity of the Association between Plasma Homocysteine and Atherothrombotic Disease: Insights from Studies of Vascular Structure and Function
- Hyperhomocysteinemia as a Risk Factor for Venous Thrombosis
- Hyperhomocysteinaemia in Patients with Peripheral Arterial Occlusive Disease
- Homocysteine, Vascular Dementia and Alzheimer's Disease
- Homocysteine in Cerebrovascular Disease: an Independent Risk Factor for Subcortical Vascular Encephalopathy
- Vascular Dysfunction in Hyperhomocyst(e)inemia. Implications for Atherothrombotic Disease
- Hyperhomocysteinemia in Chronic Renal Failure Patients: Relation to Nutritional Status and Cardiovascular Disease
- Homocysteine, Cystathionine, Methylmalonic Acid and B-Vitamins in Patients with Renal Disease
- Hyperhomocysteinemia Is Related to Residual Glomerular Filtration and Folate, but not to Methylenetetrahydrofolate-Reductase and Methionine Synthase Polymorphisms, in Supplemented End-Stage Renal Disease Patients Undergoing Hemodialysis
- Effect of Treatment of Hypothyroidism on the Plasma Concentrations of Neuroactive Steroids and Homocysteine
- Hyperhomocysteinaemia and Human Reproduction
- Homocysteine in Postmenopausal Women and the Importance of Hormone Replacement Therapy
- Does a Single Vitamin B-Supplementation Induce Functional Vitamin B-Deficiency?
- IFCC News – July 2001
