SOME METABOLIC EFFECTS AND SAFETY OF SHOR T-TERM USE OF HIGH REPLACEMENT DOSE OF CONJUGATED ESTROGENS IN POSTMENOPAUSAL WOMEN WITH CARDIOVASCULAR-DISEASES

Due to favourable action on cardiovascular system the use of unopposed estrogens can be justified in menopausal women with overt ischemic he art disease. In order to evaluate safety and some metabolic effects of short term application of high dose unopposed estrogen we gave conjug ated equine estrogens (Premarin, 1,25 mg/day) for 3 months to 14 women (12 with obvious ischemic heart disease) aged 46 - 65 years. During t his period there occurred significant decrease of plasma levels of tot al cholesterol (from 260,6+/-47,3 to 231,3+/-27,8 mg/dl, p=0,015), low density lipoprotein cholesterol (from 182,3+/-49,8 to 148,9+/-27,3 mg /dl, p=0,016), apoprotein B (from 166+/-44 to 135+/-33 mg/dl, p=0,025) , and ratio of apoproteins B to A-1 (from 1,02+/-0,28 to 0,83+/-0,2, p =0,032). There were no significant changes in plasma concentrations of triglycerides (174,6+/-83,1 to 185+/-44,3 mg/dl), high density lipopr otein cholesterol and apoprotein A-1. Of parameters of haemostasis pla sma level of antithrombin III significantly decreased (from 120+8 to 1 06+/-8%, p<0,001), while that of plasminogen rose (from 109+/-7 to 129 +/-10%, p<0,001). There were nea significant changes of fibrinogen lev el and activity of plasminogen activator inhibitor. Endometrial hyperp lasia was found after 12 weeks of therapy in 6 to 9 women subjected to hysteroscopy. These results confirm data on favorable effects of estr ogen on lipids and haemostasis and emphasize the necessity of gynaecol ogical surveillance during therapy with relatively high doses of unopp osed estrogen.