Cardiovascular effects of raloxifene: the potential for cardiovascular protection in women

The cardiovascular effects of raloxifene, as evident in a number of pre-clinical and clinical studies, suggest that raloxifene shares favourable effects of oestrogen on cardiovascular risk factors and on the vascular endothelium. There is uniform lowering of total and LDL cholesterol, without effect on HDL cholesterol or triglyceride levels. Lp(a) levels are lowered as are fibrinogen levels, with inconsistent effects on other coagulation parameters. Raloxifene lowers levels of homocysteine but does not increase CRP. Limited data suggest improvements in endothelial function. Given these potential beneficial effects on markers of cardiovascular risk, the safety profile of raloxifene assumes enormous importance. There is no histopathological evidence of endometrial stimulation and no increase in risk of endometrial cancer with raloxifene. Nor are there symptoms of breast pain or tenderness and there is a reduction in the risk of invasive breast cancer of almost 76% [55]. Additionally, there is preservation of bone mineral density and a decrease in the risk of vertebral fractures by almost 50% [46]. The only substantial side-effect is venous thromboembolic risk, which appears similar to that of oestrogen and HRT. The cardiovascular outcomes trial RUTH was therefore designed to assess the effects of raloxifene in post-menopausal women with or at high risk for coronary heart disease [56].