Clinical and lipid metabolic effects of unopposed oestrogen and two oestrogen-progestogen regimens in post-menopausal women

Hirvonen, E; Lipasti, Arja; Mälkönen, M.; Kärkkäinen, Jorma; Nuntila, J.; Timonen, Henri; Manninen, Vesa

doi:10.1016/0378-5122(87)90054-5

Cited by 40 publications

(9 citation statements)

References 27 publications

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“…Os progestógenos com ação androgênica, como o levonorgestrel (43), ou glicocorticoide, como o acetato de medroxiprogesterona (44), podem antagonizar os benefícios dos estrogênios, o que não se observa com a progesterona micronizada (45), com a didrogesterona (46) ou com a drospirenona (47).…”

Section: Hipertensão Arterialunclassified

Menopausa e síndrome metabólica

Meirelles

2014

Arq Bras Endocrinol Metab

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RESUMOA incidência de doença cardiovascular aumenta consideravelmente após a menopausa. Um dos motivos para o crescente risco cardiovascular parece ser determinado pela síndrome metabólica, da qual todos os componentes (obesidade visceral, dislipidemia, hipertensão arterial e distúrbio do metabolismo glicídico) se associam à maior incidência de coronariopatia. Após a menopausa, a sín-drome metabólica é mais prevalente do que na pré-menopausa, podendo ter importante papel na ocorrência de infarto do miocárdio e outras morbidades ateroscleróticas e cardiovasculares. A obesidade, componente primordial da síndrome metabólica, se associa ainda ao aumento da incidência de câncer de mama, endométrio, intestino, esôfago e rim. O tratamento da síndrome metabólica se baseia na mudança de hábitos de vida e, quando necessário, no emprego de medicação dirigida aos seus componentes. Na presença de sintomas de síndrome do climatério, a terapia hormonal, quando indicada, concorrerá também para a melhora da síndrome metabólica. Arq Bras Endocrinol Metab. 2014;58(2):91-6Descritores Menopausa; síndrome metabólica; terapia hormonal da menopausa; resistência insulínica; estrogênios ABSTRACTThe incidence of cardiovascular disease increases considerably after the menopause. One reason for the increased cardiovascular risk seems to be determined by metabolic syndrome, in which all components (visceral obesity, dyslipidemia, hypertension, and glucose metabolism disorder) are associated with higher incidence of coronary artery disease. After menopause, metabolic syndrome is more prevalent than in premenopausal women, and may plays an important role in the occurrence of myocardial infarction and other atherosclerotic and cardiovascular morbidities. Obesity, an essential component of the metabolic syndrome, is also associated with increased incidence of breast, endometrial, bowel, esophagus, and kidney cancer. The treatment of metabolic syndrome is based on the change in lifestyle and, when necessary, the use of medication directed to its components. In the presence of symptoms of the climacteric syndrome, hormonal therapy, when indicated, will also contribute to the improvement of the metabolic syndrome. Arq Bras Endocrinol Metab. 2014;58 (2) INTRODUÇÃO A s doenças cardiovasculares são a maior causa de mortalidade em ambos os sexos e sua incidência em mulheres no menacme é menor do que nos homens de mesma idade, diminuindo progressivamente essa diferença com o envelhecimento e o advento da menopausa (1). Considerando-se apenas o sexo feminino, o estudo de Framingham mostrou que a incidência anual de doença cardiovascular em mulheres com menos de 55 anos na pré-menopausa, quando comparada à de mulheres, na mesma faixa etária, nas quais já ocorrera a menopausa, foi cerca de 50% menor (2). A falência ovariana parece, portanto, ser um divisor de águas, em termos de risco cardiovascular.Um dos fatores que aumentam o risco de mortalidade, em homens e mulheres, é a síndrome metabólica. A Third National Health and Nutrition Examination Survey (NH...

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Section: Hipertensão Arterialunclassified

Menopausa e síndrome metabólica

Meirelles

2014

Arq Bras Endocrinol Metab

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“…Elevated serum total cholesterol (Chol) and low density lipoprotein cholesterol (LDL-Chol) are both well known risk factors as regards CHD, whereas elevated concentrations of high density lipoprotein cholesterol (HDL-Chol) appear to protect against CHD. The concentrations of HDL-Chol increase by 10-20% and those of LDL-Chol decrease by 10-20% during estrogen therapy (9,10). Increased concentrations of serum triglycerides (TG) are associated with an increased risk of CHD in women over the age of 50 (11).…”

Section: Introductionmentioning

confidence: 99%

Long-term vitamin D3 supplementation may have adverse effects on serum lipids during postmenopausal hormone replacement therapy

Heikkinen

Tuppurainen

Niskanen

et al. 1997

European Journal of Endocrinology

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Objective: The positive short-term effects of postmenopausal hormone replacement therapy (HRT) on serum lipids are well known, but it has been suggested that they vanish with time. Cholecalciferol (vitamin D 3 ) is widely used to prevent postmenopausal osteoporosis but the influence of vitamin D 3 on serum lipids is poorly known. The long-term effects of HRT and vitamin D 3 on the concentrations of serum lipids were studied in a population-based prospective 3-year study. Design and methods: 464 women were randomized into four treatment groups: (i) HRT (sequential combination of 2 mg estradiol valerate and 1 mg cyproterone acetate), (ii) Vit D 3 (vitamin D 3 300 IU/ day), (iii) HRT+Vit D 3 (both as above), (iv) placebo (calcium lactate 500 mg/day). Results: 320 women completed the study. After three years of treatment, serum concentrations of low density lipoprotein (LDL) cholesterol decreased in the HRT group (10.1%, P<0.001) and the HRT+Vit D 3 group (5.9%, P=0.005), increased in the Vit D 3 group (4.1%, P=0.035) but remained unchanged in the placebo group. The concentrations of total cholesterol decreased by 5.8% in the HRT group (P<0.001) and by 3.3% in the HRT+Vit D 3 group (P=0.023), but did not change in the other two groups. Serum concentrations of high density lipoprotein (HDL) cholesterol decreased in the Vit D 3 group (5.2%, P=0.001), HRT+Vit D 3 group (3.7%, P=0.046), and the placebo group (4.5%, P=0.006) but did not change significantly in the HRT group. The HDL/LDL ratio increased in the HRT group (10.5%, P=0.006) and decreased in the Vit D 3 group (10.5%, P<0.001) whereas no changes occurred in the other two groups. In addition, serum triglycerides increased similarly in all groups (14.0-18.8%, P<0.05-0.001). Conclusions: Our results confirm the positive long-term effect of HRT with sequential estradiol valerate and cyproterone acetate on serum lipid concentrations. In addition, the results suggest that vitamin D 3 supplementation may have unfavorable effects on lipids in postmenopausal women. Pure vitamin D 3 treatment was associated with increased serum LDL cholesterol. Furthermore, the beneficial effects of HRT on serum LDL cholesterol content were reduced when estradiol valerate was combined with vitamin D 3 . However, the relevance of these associations to cardiovascular morbidity remains to be established. [495][496][497][498][499][500][501][502] European Journal of Endocrinology 137

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“…On the other hand, a weaker attenuation with the smaller levonorgestrel dose on the oestrogen‐induced changes in HDL cholesterol may explain part of the difference. Hirvonen et al 14 compared the effect of oral levonorgestrel and medroxyprogesterone acetate in postmenopausal women in combination with oral oestradiol. Formulations containing levonorgestrel induced a fall in HDL cholesterol whereas medroxyprogesterone acetate lead to an increase.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the effects on the serum lipid profile of the three regimens were assessed. Both oral levonorgestrel combined with oral oestrogen replacement therapy 14,15 and intrauterine levonorgestrel combined with transdermal oestrogen replacement therapy 16 is known to reduce HDL cholesterol concentration in postmenopausal women. This may be eliminated with the smaller release rate of levonorgestrel from the menopausal levonorgestrel system when compared with that of the levonorgestrel intrauterine system.…”

Section: Introductionmentioning

confidence: 99%