A Comparison of Estrogen Replacement, Pravastatin, and Combined Treatment for the Management of Hypercholesterolemia in Postmenopausal Women

Abstract

Administration of conjugated estrogens resulted in potentially antiatherogenic changes in levels of non-HDL-C, HDL-C, and calculated LDL-C. The HDL-C response to combined treatment was similar to that observed in women taking conjugated estrogens alone, while the non-HDL-C and LDL-C responses to combined treatment were similar to those produced by pravastatin therapy alone. These findings support the position of the National Cholesterol Education Program that estrogen replacement, with a progestin where indicated, should be given consideration as a therapeutic option for the management of hypercholesterolemia in postmenopausal women.

Prevention of cardiovascular events in early menopause: A possible role for hormone replacement therapy

“…Despite the above evidences in early and surgical menopause [5,[10][11][12][13] and the results of observational studies suggesting that postmenopausal hormone replacement therapy (HRT) could be beneficial for the heart [14], randomized placebo-controlled trials (RCT) recruiting women aged 50 to 79 years have shown no benefit but instead an increased rate of cardiac and thromboembolic events [15]. Probably, the age at menopause and the years since menopause at the beginning of HRT administration may influence its effects on cardiovascular system [16].…”

Statins, hormones, and women: Benefits and drawbacks for atherosclerosis and osteoporosis

“…The combination of statins plus HRT produced significantly greater reductions in LDL than either therapy alone. In the studies by Davidson et al [27] and Herrington et al [25], statin therapy plus HRT produced dramatic 41.4% and 47.6% reductions in LDL/HDL ratios, respectively. Of note, in a preliminary report of a secondary analysis from HERS, the combination of HRT plus statin therapy produced no greater reduction in clinical events than statin therapy alone [28].…”

“…Furthermore, because both statins and HRT lower LDL through separate mechanisms, some investigators have examined whether the combination of statins and HRT is more efficacious than either one alone. Table 2 summarizes the results of five studies that have performed head-to-head comparisons of statin therapy versus HRT and in some cases statins plus HRT, in either a crossover [23][24][25] or parallel clinical trial design [26,27]. In these studies, statins were more effective than HRT at lowering LDL, whereas HRT was more effective at raising HDL.…”

Continuation of hormone replacement therapy during acute myocardial infarction after the women's health initiative study. Is it the time for change?

“…HRT produced a smaller decrease in total cholesterol; and in LDL-cholesterol, a smaller decrease in LDLcholesterol, a smaller elevation in HDL-cholesterol and an increase in triglyceride levels [24 -28]. Combination therapy appeared to be more effective than either agent alone [28,29]. In our view, an abrupt stop of HRT may result in a decrease in these favorable effects on the plasma lipids, and this may interfere with coronary plaque stability during the acute phase of MI.…”