EFFICACY OF SEQUENTIAL HORMONE REPLACEMENT THERAPY IN THE TREATMENT OF HYPERCHOLESTEROLEMIA AMONG POSTMENOPAUSAL WOMEN

Objectives. To test the efficacy of hormone replacement therapy (HRT) and dietary therapy, compared to dietary therapy, in lowering LDL chol esterol levels among postmenopausal women. Design. A prospective paral lel randomized study of sequential 17 beta-oestradiol and norethistero ne acetate or placebo for 48 weeks. Setting. A University outpatient l ipid clinic. Subjects. A total of 76 postmenopausal women, aged 43-60 years, with LDL cholesterol levels greater than or equal to 4.2 mmol I -1, treated with a lipid-lowering diet. Main outcome measures, Levels of lipids, lipoproteins, apolipoproteins, fibrinogen and glucose toler ance. Results, Adherence to the diet was similar in both groups. Total and LDL cholesterol levels were reduced by 14% (95% CI, 11-17%) and 1 9% (95% CI, 14-23%), respectively, in the HRT group vs. 3% (95% CI, 0- 7%) and 5% (95% CI, 0-11%) in the diet group. HRT reduced the levels o f apolipoprotein B and lipoprotein(a). Levels of HDL cholesterol, HDL( 2), HDL(3), triglycerides, lipoprotein populations and apolipoproteins AE and AII remained unchanged. No adverse effects on glucose toleranc e or on fibrinogen levels were observed. The reduction in LDL choleste rol was positively correlated with initial levels of LDL cholesterol a nd negatively correlated with body mass index. Conclusions. HRT is eff ective in reducing elevated LDL cholesterol levels, and should be cons idered in the treatment of hyperlipidaemic postmenopausal women, in ad dition to dietary therapy.