Comment on Lack of Effect of Raloxifene on Coronary Artery Atherosclerosis of Postmenopausal Monkeys

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Abstract
Clarkson et al. (1) reported in this journal that raloxifene failed to attenuate the development of atheromas in coronary arteries of ovariectomized (OVX) cynomolgus monkeys. In the same study, OVX monkeys treated with conjugated equine estrogen (CEE) had significantly less coronary artery atheroma compared with untreated estrogen-deficient animals. This study was contracted by Lilly Research Laboratories with the Department of Comparative Medicine at the Bowman Gray School of Medicine. From the results of this study, the authors draw strong conclusions regarding the clinical relevance of these data, stating that any benefit of raloxifene to prevent bone loss in postmenopausal women would be “…at the expense of any protection against coronary artery atherosclerosis.” We disagree with this interpretation of the data and feel it important to clarify some issues with this particular study that, although not discussed in the paper, are important in evaluating the validity of the conclusions therein. Three key areas of concern are: 1) excessive blood levels of estrogen in the CEE-treated group, 2) low sensitivity of the study, and 3) the comparability of this experiment relative to historical results in this model.

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