12404199

pubmed:Citation

11

Hormone replacement therapy (HRT) seems to have a favorable influence on the plasma lipid profile. Only a few investigations have examined the effects of HRT versus hepatic hydroxymethyl glutaryl coenzyme A (HMG-CoA) reductase inhibitors. We compared the relative effects of different hypolipidemic strategies on lipoproteins and coagulative parameters in women with recent-onset spontaneous menopause. In this 24-week, placebo-controlled trial, 60 consecutive healthy women aged >/= 45 years, with amenorrhea from 6 to 60 months (mean, 1.9 +/- 1.4 years), serum follicle stimulating hormone (FSH) greater than 40 U/L, and slight to moderate hypercholesterolemia (low-density lipoprotein-cholesterol [LDL-C] 160 to 250 mg/dL, high-density lipoprotein-cholesterol [HDL-C] < 75 mg/dL, and triglycerides < 200 mg/dL) were enrolled and randomized to dietetic advice (placebo group), simvastatin 10 mg, 0.625 mg of conjugated equine estrogen (CEE), or 50 microg estrogen transdermal patch (ETP). In the latter 2 cases, the progestative nomegestrol was added to estrogens (days 17 to 28 of the cicle). Lipoprotein parameters were evaluated after separating very-low-density lipoproteins (VLDLs) by ultracentrifugation, while fasting glucose and insulin, homocysteine, and hemocoagulative parameters were determined in plasma. Fifty-four patients completed the trial. Total cholesterol (TC) and LDL-C significantly decrased in the simvastatin (-62 mg/dL [-20%] and -72 mg/dL [-30%], respectively), CEE (-42 mg/dL [-13%] and -45 mg/dL [-18%]), and ETP (-30 mg/dL [-10%] and -26 mg/dL [-11%]) groups compared to baseline, but only simvastatin showed an effect significantly superior to diet alone. Apolipoprotein (Apo) B was decreased by simvastatin (-25%, P <.001) and by CEE (-10%, P <.05); again, simvastatin was more effective than either diet or ETP. Triglyceride concentration and VLDL-C were unmodified by treatments. HDL-C and Apo A-I significantly increased in the simvastatin group (+18% and +8%, respectively), while HDL-C was unmodified by both HRT regimens and Apo A-I was reduced by ETP treatment (-17%); lipoprotein[a] (Lp[a]) was decreased by both HRTs (-38%, P <.05, and -22%, P =.07, for CEE and ETP, respectively). Among coagulative parameters, plasminogen activator inhibitor-1 (PAI-1) was significantly reduced by CEE (-29%, P <.05) but not ETP treatment (+16%, P = not significant), while fibrinogen, antithrombin, and homocysteine were unaffected by therapy. Thus, HRT, particularly CEE, seems well tolerated and moderately effective in improving the lipid pattern and, perhaps, the coagulative/fibrinolytic balance in postmenopausal hypercholesterolemic women; it may represent a therapeutic option in slightly dyslipidemic subjects. Statins are preferred in case of more severe disease.

http://linkedlifedata.com/resource/pubmed/journal/0375267

http://linkedlifedata.com/resource/pubmed/chemical/Anticholesteremic Agents, http://linkedlifedata.com/resource/pubmed/chemical/Antithrombin III, http://linkedlifedata.com/resource/pubmed/chemical/Apolipoprotein A-I, http://linkedlifedata.com/resource/pubmed/chemical/Apolipoproteins B, http://linkedlifedata.com/resource/pubmed/chemical/Cholesterol, HDL, http://linkedlifedata.com/resource/pubmed/chemical/Cholesterol, LDL, http://linkedlifedata.com/resource/pubmed/chemical/Estrogens, Conjugated (USP), http://linkedlifedata.com/resource/pubmed/chemical/Fibrinogen, http://linkedlifedata.com/resource/pubmed/chemical/Homocysteine, http://linkedlifedata.com/resource/pubmed/chemical/Hydroxymethylglutaryl-CoA..., http://linkedlifedata.com/resource/pubmed/chemical/Lipids, http://linkedlifedata.com/resource/pubmed/chemical/Lipoprotein(a), http://linkedlifedata.com/resource/pubmed/chemical/Plasminogen Activator Inhibitor 1, http://linkedlifedata.com/resource/pubmed/chemical/Progestins, http://linkedlifedata.com/resource/pubmed/chemical/Simvastatin, http://linkedlifedata.com/resource/pubmed/chemical/Triglycerides

Nov

pubmed-author:BarbanAngelaA, pubmed-author:BonaccorsiGloriaG, pubmed-author:DonegàPaolaP, pubmed-author:FellinRenatoR, pubmed-author:MollicaGioacchinoG, pubmed-author:PansiniFrancescoF, pubmed-author:PassaroAngelinaA, pubmed-author:VignaGiovanni BGB, pubmed-author:ZancaRosannaR

Print

NLM

1463-70

pubmed-meshheading:12404199-Administration, Cutaneous, pubmed-meshheading:12404199-Administration, Oral, pubmed-meshheading:12404199-Anticholesteremic Agents, pubmed-meshheading:12404199-Antithrombin III, pubmed-meshheading:12404199-Apolipoprotein A-I, pubmed-meshheading:12404199-Apolipoproteins B, pubmed-meshheading:12404199-Cholesterol, HDL, pubmed-meshheading:12404199-Cholesterol, LDL, pubmed-meshheading:12404199-Estrogen Replacement Therapy, pubmed-meshheading:12404199-Estrogens, Conjugated (USP), pubmed-meshheading:12404199-Female, pubmed-meshheading:12404199-Fibrinogen, pubmed-meshheading:12404199-Homocysteine, pubmed-meshheading:12404199-Humans, pubmed-meshheading:12404199-Hydroxymethylglutaryl-CoA Reductase Inhibitors, pubmed-meshheading:12404199-Hypercholesterolemia, pubmed-meshheading:12404199-Lipids, pubmed-meshheading:12404199-Lipoprotein(a), pubmed-meshheading:12404199-Middle Aged, pubmed-meshheading:12404199-Plasminogen Activator Inhibitor 1, pubmed-meshheading:12404199-Postmenopause, pubmed-meshheading:12404199-Progestins, pubmed-meshheading:12404199-Simvastatin, pubmed-meshheading:12404199-Treatment Outcome, pubmed-meshheading:12404199-Triglycerides

Simvastatin, transdermal patch, and oral estrogen-progestogen preparation in early-postmenopausal hypercholesterolemic women: a randomized, placebo-controlled clinical trial.

Journal Article, Clinical Trial, Randomized Controlled Trial