EFFECTS OF CONTINUOUS COMBINED HORMONE-REPLACEMENT THERAPY ON LIPID-LEVELS IN HYPERCHOLESTEROLEMIC POSTMENOPAUSAL WOMEN

PURPOSE: To test the lipid-lowering effects of continuous combined hor mone-replacement therapy in hypercholesterolemic postmenopausal women. PATIENTS AND METHODS: A total of 32 postmenopausal women identified t hrough health fair and cholesterol screening records, whose ad libitum low-density lipoprotein (LDL) cholesterol level (mean of 2 measuremen ts) was >130 mg/dL, and whose fasting triglycerides were <250 mg/dL, p articipated in a placebo-controlled, nonrandomized trial testing the l ipid-lowering effect of continuous combined hormone-replacement therap y. Women with a history of uterine fibroids, thrombophlebitis, family or personal history of breast cancer, or recent hormone use were exclu ded. After a 1-month period to standardize baseline dietary intake (Hi -Sat), patients were taught a cholesterol-lowering, Step-One diet, whi ch they followed for the remainder of the study. After 3 months, patie nts supplemented the Step-One diet with dairy placebo tablets for 3 mo nths, followed by supplementation with conjugated estrogens 0.625 mg/d plus medroxyprogesterone 2.5 mg/d for 3 months. The means of five fas ting lipid and lipoprotein values at the end of each 3-month supplemen tation period were compared. RESULTS: Total cholesterol fell from 261 mg/dL to 250 mg/dL to 233 mg/dL, with LDL reduction from 181 mg/dL to 173 mg/dL to 150 mg/dL, on diet and diet plus continuous combined horm one-replacement therapy, respectively (all P <0.05). Whereas 26 of the 32 women had LDL values above 160 mg/dL during the Hi-Sat diet, only 10 of the 32 women remained with LDL values in this range during Step- One diet plus hormone therapy. Besides improving LDL cholesterol level s, continuous combined hormone-replacement therapy was associated with an increase in high density lipoprotein (HDL) cholesterol levels from 51 mg/dL to 54 mg/dL (P <0.05). The 2 women whose HDL cholesterol lev els were <35 mg/dL during the Step-One diet plus placebo achieved HDL cholesterol levers >35 mg/dL during hormone therapy. Nevertheless, con tinuous combined hormone-replacement therapy was associated with a hig h frequency of side effects, including breast tenderness and uterine b leeding. Most bothersome side effects dissipated after an initial adju stment period. CONCLUSIONS: Continuous combined hormone-replacement th erapy can produce significant and therapeutic reductions in LDL choles terol levels in hypercholesterolemic postmenopausal women. After inter nists become familiar with the expected side effects and their time co urse, this regimen may provide an effective approach in the management of hypercholesterolemia in postmenopausal women who have not undergon e hysterectomy.