The effect of continuous combined conjugated equine estrogen plus medroxyprogesterone acetate and tibolone on cardiovascular metabolic risk factors.
OBJECTIVE
Hormone treatment (HT) after the menopause affects lipid and carbohydrate metabolism and inflammation and may modify risk factors relevant for the clinical expression of the metabolic syndrome and cardiovascular disease. Tibolone has pharmacodynamic properties different from other hormone preparations. Here, we compare the effect of combined HT and tibolone on metabolic risk markers for the development of cardiovascular disease.


METHODS
Postmenopausal women were randomly assigned to 1.25 or 2.5 mg/day of tibolone or oral continuous combined conjugated equine estrogen plus medroxyprogesterone acetate (CEE/MPA). Cardiovascular risk factors were determined at baseline and after 12 months of treatment.


RESULTS
Body mass index and blood pressure were unaffected by the HT. HOMA-IR decreased in the CEE/MPA group (3.69 vs. 3.38; p = 0.02). Treatment with tibolone increased tissue-type plasminogen activator activity (0.87 IU/ml vs. 1.21 IU/ml; p = 0.005) and C-reactive protein (0.83 mg/l vs. 1.88 mg/l; p < 0.001), and decreased plasminogen activator inhibitor activity (6.9 IU/ml vs. 2.0 IU/ml; p < 0.001) and triglycerides (0.99 vs. 0.87 mmol/l; p = 0.004). Both treatments decreased total cholesterol significantly.


CONCLUSIONS
CEE/MPA and tibolone have comparable effects on most metabolic risk factors investigated. The effect of tibolone on fibrinolysis and triglycerides suggests that tibolone has a favorable pharmacological profile on these risk factors when compared to CEE/MPA.
Skouby
S O
SO
Department of Obstetrics and Gynecology, Herlev Hospital, University of Copenhagen, Denmark.
Sidelmann
J J
JJ
Nilas
L
L
Gram
J
J
Jespersen
J
J
D001794:Blood Pressure / Q000187:drug effects; D001823:Body Composition / Q000187:drug effects; D002096:C-Peptide / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D020847:Estrogen Receptor Modulators / Q000008:administration & dosage*; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage*; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D024821:Metabolic Syndrome / Q000517:prevention & control*; D008875:Middle Aged; D009652:Norpregnenes / Q000008:administration & dosage* / Q000494:pharmacology; D010959:Tissue Plasminogen Activator / Q000187:drug effects; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
D002096:C-Peptide; D020847:Estrogen Receptor Modulators; D004966:Estrogens, Conjugated (USP); D009652:Norpregnenes; D014280:Triglycerides; D017258:Medroxyprogesterone Acetate; D010959:Tissue Plasminogen Activator; C027385:tibolone