Metabolic effects of estrogens and progestins.
OBJECTIVE
To review the effects of exogenous estrogen and progestin on metabolic risk factors for coronary artery disease in women.


METHODS
Review of selected literature.


METHODS
Population studies and clinical trials.


METHODS
Premenopausal and postmenopausal women.


METHODS
Exogenous gonadal hormones in oral contraceptives and hormone replacement regimens.


METHODS
Lipoprotein, hemostatic, carbohydrate, and blood pressure metabolic parameters.


RESULTS
Favorable lipoprotein changes have been demonstrated in both observational studies and clinical trials of effects of exogenous hormones on cardiovascular risk factors in women. These include declines in low-density lipoprotein, apoprotein B, and lipoprotein(a), and increases in high-density lipoprotein (HDL), HDL2, and apoprotein A-I. Hormone replacement effects on triglyceride are minor and, in most patients, probably benign. Evidence is unconvincing that clinically significant changes in clotting factors, carbohydrate metabolism, or blood pressure take place as a result of postmenopausal hormone interventions. In fact, carbohydrate metabolism and blood pressure may be improved slightly. Metabolic studies do not, thus far, provide any contraindications to either estrogen replacement therapy (ERT) or hormone replacement therapy (HRT) in appropriately selected subjects. However, because studies of metabolic risk factors generally have been done in patients who were not hyperlipidemic, hypercoagulable, hyperglycemic, or hypertensive, little is known about the metabolic effects of ERT or HRT on pre-existing metabolic abnormalities.
Tulane University Medical Center, New Orleans, Louisiana 70112-2699.
J C
JC
LaRosa
D001794:Blood Pressure / Q000187:drug effects; D001808:Blood Vessels / Q000187:drug effects; D050260:Carbohydrate Metabolism; D002986:Clinical Trials as Topic; D003276:Contraceptives, Oral; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology; D004333:Drug Administration Routes; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000494:pharmacology*; D005260:Female; D006490:Hemostatics / Q000378:metabolism*; D006801:Humans; D008074:Lipoproteins / Q000378:metabolism*; D017698:Postmenopause; D017697:Premenopause; D011372:Progestins / Q000494:pharmacology*; D012307:Risk Factors
D003276:Contraceptives, Oral; D004967:Estrogens; D006490:Hemostatics; D008074:Lipoproteins; D011372:Progestins