Effect of Hormone Replacement Therapy on Lipoprotein(a) and Lipid Levels in Postmenopausal Women

Abstract

High concentrations of lipoprotein(a) [Lp(a)], an independent risk factor for atherosclerosis, cannot be managed by the usual lipid-lowering agents. It has been suggested that Lp(a) levels are related to female sex hormones. Estrogen replacement therapy makes the lipid profiles favorable for delaying atherosclerosis in postmenopausal women. The effects of the combination therapy of estrogen and progesterone on lipids are controversial. This study was designed to evaluate the effect of female sex hormones on the concentration of Lp(a) and to clarify the influence of progesterone on the effect of estrogen in postmenopausal women. Postmenopausal women (n=184) were divided into four groups: control; 0.625 mg conjugated equine estrogen (CEE) plus 10 mg medroxyprogesterone acetate (MPA); 0.625 mg CEE plus 5 mg MPA; and 0.625 mg CEE only. Medication for 2 months lowered the concentrations of Lp(a) by 20% in all treated groups. The decrease was more pronounced in subjects with a relatively higher basal Lp(a) concentration. Estrogen replacement therapy raised the concentration of high-density lipoprotein cholesterol and decreased low-density lipoprotein cholesterol without changing total cholesterol. The combination therapy of estrogen and progesterone abolished the effect of estrogen on highdensity lipoprotein cholesterol. Hormone replacement therapy lowered Lp(a) levels in postmenopausal women. The effect was prominent in subjects with high basal Lp(a) levels. This decrease may be one of the mechanisms of the cardioprotective effects of estrogen. The cardioprotective effect of estrogen cannot be applied to the combination therapy due to the adverse effect of progesterone on high-density lipoprotein cholesterol. It cannot be lowered by the usual treatments for hyperlipidemia, 912 and only a few drugs reduce Lp(a) concentrations. 1318 Recently, epidemiological investigations have reported that concentrations of Lp(a) are higher in postmenopausal women than in premenopausal women 19 and that postmenopausal women taking female sex hormones have lower Lp(a) levels than those not taking such medication. 20 Small-sized studies 21 -22 also show that hormone replacement therapy (HRT) in postmenopausal women lowers the concentration of Lp(a) markedly.Premenopausal women have lower cardiovascular morbidity and mortality than men of a similar age. After menopause, the incidence of cardiovascular diseases increases and no difference is noticed during the eighth decade between men and women. 23 Female sex hormones have been used for the alleviation of postmenopausal symptoms and the treatment of osteoporosis. Most but not all reports have shown that estrogen replacement therapy in postmenopausal women re-

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Active DHEA uptake in the prostate gland correlates with aggressive prostate cancer

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“…et Haines et al, 1996;Kim et al, 1996;Hänggi Blood samples for measurement of serum Lp(a), oestradiol and et Espeland et al, 1998;Spencer et al, 1999).…”