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Differential Effects of E and Droloxifene on C-Reactive Protein and Other Markers of Inflammation in Healthy Postmenopausal Women

Departments of Internal Medicine/Cardiology (D.M.H., B.E.P.) and Hypertension and Vascular Research Center (K.B.B.), Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157; Department of Medicine, Brigham and Women’s Hospital (E.W.S., P.M.R.) and Children’s Hospital Medical Center (N.R.), Boston, Massachusetts 02115; and Division of Experimental Medicine, Pfizer, Inc., Central Research (D.B.M.), Groton, Connecticut 06340

Address all correspondence and requests for reprints to: David M. Herrington, M.D., M.H.S., Department of Internal Medicine/Cardiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1045. E-mail: arichrds{at}wfubmc.edu

Abstract

Although increased levels of C-reactive protein have been linked to E therapy, the significance of this finding and whether it occurs with the selective ER modulators are unknown. Thirty-five healthy postmenopausal women were enrolled in a placebo-controlled, two-period cross-over design trial to evaluate the effects of 0.625 mg oral conjugated E and 60 mg droloxifene, a structural analog of tamoxifen, on serum levels of C-reactive protein, IL-6, and endothelial cell adhesion molecules. E treatment resulted in 65.8% higher levels of C-reactive protein (P = 0.0002) and 48.1% higher levels of IL-6 (P < 0.001), but also resulted in a 10.9% reduction in soluble E-selectin (P = 0.002) and borderline reductions in vascular cell adhesion molecule-1. In contrast, droloxifene had no effect on C-reactive protein and IL-6, but did produce a significant 11% reduction in E-selectin (P < 0.00001). However, droloxifene also resulted in an 11.6% increase in vascular cell adhesion molecule-1 (P < 0.007).

These data provide additional evidence of a proinflammatory effect of E that may have adverse cardiovascular consequences. However, these changes were also accompanied by a reduction in E-selectin, suggesting an antiinflammatory effect at the level of the endothelium. The net clinical impact of these changes is not yet well established. In contrast, droloxifene had little or no proinflammatory effects on C-reactive protein and IL-6 and had mixed effects on endothelial adhesion molecules. This observation provides additional rationale for continuing to evaluate the potential cardiovascular benefits of selective ER modulators.

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