title: Effect of hormone replacement therapy, tibolone and raloxifene on serum lipids, apolipoprotein A1, apolipoprotein B and lipoprotein(a) in Greek postmenopausal women.
abstract: The aim of this study was to assess the effect of estrogen, two regimens of continuous combined hormone replacement therapy (HRT), tibolone and raloxffene on serum lipid, apolipoprotein A1 and B and lipoprotein(a) levels in Greek postmenopausal women. A total of 350 postmenopausal women were studied in a prospective open design. Women were assigned to one of the following regimens depending on the presence of risk factors for osteoporosis, dimacteric symptoms and an intact uterus: conjugated equine estrogen 0.625 mg (CEE, n = 34), continuous combined CEE 0.625 mg plus medroxyprogesterone acetate (MPA) 5 mg, (n = 80), continuous combined 17beta-estradiol 2 mg plus norethisterone acetate (NETA) 1 mg (n = 58), tibolone 2.5 mg (n = 83) and raloxifene HCl 60 mg (n = 50). Forty-five postmenopausal women with no indications for HRT served as controls. Total cholesterol (TC), low-density lipoprotein (LDL) cholestrol and high-density lipoprotein (HDL) cholesterol, triglyceride (TG), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB) and lipoprotein(a) (Lp(a)) levels were assessed in each subject at baseline, and at 6 and 12 months of therapy. All therapy regimens lowered TC levels compared to baseline (4.2-8.0% decrease). This effect was more prominent in the subgoup of women with high baseline TC levels (9.1-20.4% decrease). LDL cholesterol decreased significantly in CEE, CEE/MPA and raloxifene groups (-11.2%, -11.9% and -11.0%, respectively). Hypercholesterolemic women exhibited a steeper decrease in LDL cholesterol (10.6-27.8% in all therapy groups). TG levels increased significantly in the CEE and CEE/MPA groups (23.7% and 21.8%, respectively), while estradiol/NETA had no effect on TG levels. Tibolone decreased TG levels markedly, by 20.6%, while raloxifene had no TG-lowering effect. HDL cholesterol and ApoA1 were increased by CEE and CEE/MPA (HDL cholesterol, 7.4% and 11.8%, respectively; ApoA1, 17.8% and 7.9%, respectively) and decreased by tibolone (HDL cholesterol, -13.6%; and ApoA1, -9.9%). All therapy regimens except raloxifene lowered Lp(a) levels, with tibolone having the more pronounced effect (-13.2 to -29.0%). In conclusion, each therapy regimen had a diferent effect on lipid-lipoprotein levels, exerting favorable and unfavorable modifications. Hypercholesterolemic women seemed to benefit more from the cholesterol-lowering effect of estrogen replacement therapy/HRT. The choice for a particular regimen should be based on individual needs, indications and lipid-lipoprotein profile.
authors.affiliation: 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece.
authors.forename: G E
authors.initials: GE
authors.lastname: Christodoulakos
authors.forename: I V
authors.initials: IV
authors.lastname: Lambrinoudaki
authors.forename: C P
authors.initials: CP
authors.lastname: Panoulis
authors.forename: C A
authors.initials: CA
authors.lastname: Papadias
authors.forename: E E
authors.initials: EE
authors.lastname: Kouskouni
authors.forename: G C
authors.initials: GC
authors.lastname: Creatsas
mesh_terms: D000328:Adult; D000368:Aged; D016632:Apolipoprotein A-I / Q000097:blood; D001053:Apolipoproteins / Q000097:blood*; D001055:Apolipoproteins B / Q000097:blood; D002784:Cholesterol / Q000097:blood; D004958:Estradiol / Q000494:pharmacology / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy / Q000379:methods*; D004966:Estrogens, Conjugated (USP) / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006115:Greece; D006801:Humans; D008055:Lipids / Q000097:blood*; D017270:Lipoprotein(a) / Q000097:blood; D017258:Medroxyprogesterone Acetate / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D009640:Norethindrone / Q000494:pharmacology / Q000627:therapeutic use; D009652:Norpregnenes / Q000494:pharmacology* / Q000627:therapeutic use; D017698:Postmenopause / Q000097:blood*; D020849:Raloxifene Hydrochloride / Q000494:pharmacology* / Q000627:therapeutic use; D020845:Selective Estrogen Receptor Modulators / Q000494:pharmacology* / Q000627:therapeutic use; D014280:Triglycerides / Q000097:blood
chemical_list: D016632:Apolipoprotein A-I; D001053:Apolipoproteins; D001055:Apolipoproteins B; D004966:Estrogens, Conjugated (USP); D008055:Lipids; D017270:Lipoprotein(a); D009652:Norpregnenes; D020845:Selective Estrogen Receptor Modulators; D014280:Triglycerides; D020849:Raloxifene Hydrochloride; D004958:Estradiol; D002784:Cholesterol; D017258:Medroxyprogesterone Acetate; C027385:tibolone; D009640:Norethindrone