Effects of conjugated equine estrogen with and without three different progestogens on lipoproteins, high-density lipoprotein subfractions, and apolipoprotein A-I.
The effects of conjugated equine estrogen and subsequent cyclical progestogen supplementation on lipoprotein and apolipoprotein A-I levels were investigated in three groups of postmenopausal women. Unopposed conjugated equine estrogen (0.625 mg) lowered total cholesterol 4-8% and low-density lipoprotein (LDL) cholesterol 12-19% below pre-treatment levels in all three groups. Levels of high-density lipoprotein (HDL) cholesterol and apolipoprotein A-I were increased 9-13 and 9-18%, respectively, with unopposed estrogen. The increase in HDL cholesterol was mainly due to increases in the high-density lipoprotein2 (HDL2) subfraction. Addition of medroxyprogesterone acetate, norethindrone acetate, or d,l-norgestrel at doses shown previously to provide protection against endometrial hyperplasia reversed some of the beneficial estrogen effects, reducing levels of HDL cholesterol 14-17%, HDL2 cholesterol 22-37%, and apolipoprotein A-I 11-15% from those obtained with unopposed estrogen. The LDL cholesterol levels fell 12-19% with unopposed estrogen but remained 7-12% below baseline when progestogens were added. These observations demonstrate that after 3 months of treatment, all three progestogens reversed some of the favorable effects of unopposed estrogen on lipoproteins but permitted a continued modest reduction in LDL cholesterol.
Miller
V T
VT
Department of Medicine, George Washington University Medical Center, Washington, DC.
Muesing
R A
RA
LaRosa
J C
JC
Stoy
D B
DB
Phillips
E A
EA
Stillman
R J
RJ
D000328:Adult; D016632:Apolipoprotein A-I; D001054:Apolipoproteins A / Q000187:drug effects*; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000187:drug effects*; D015914:Estrogen Replacement Therapy; D004966:Estrogens, Conjugated (USP) / Q000494:pharmacology; D005260:Female; D006801:Humans; D008074:Lipoproteins / Q000187:drug effects*; D008525:Medroxyprogesterone / Q000031:analogs & derivatives / Q000494:pharmacology; D017258:Medroxyprogesterone Acetate; D008593:Menopause / Q000097:blood / Q000187:drug effects*; D008875:Middle Aged; D009640:Norethindrone / Q000031:analogs & derivatives / Q000494:pharmacology; D000077563:Norethindrone Acetate; D009644:Norgestrel / Q000494:pharmacology; D012738:Sex Hormone-Binding Globulin / Q000187:drug effects
D016632:Apolipoprotein A-I; D001054:Apolipoproteins A; D008076:Cholesterol, HDL; D004966:Estrogens, Conjugated (USP); D008074:Lipoproteins; D012738:Sex Hormone-Binding Globulin; D009644:Norgestrel; D002784:Cholesterol; D000077563:Norethindrone Acetate; D017258:Medroxyprogesterone Acetate; D008525:Medroxyprogesterone; D009640:Norethindrone