EFFECTS OF ESTROGEN REPLACEMENT THERAPY ON THE LIPOPROTEIN PROFILE INPOSTMENOPAUSAL WOMEN WITH ESRD

Background. Patients with ESRD have excessive cardiovascular morbidity and mortality. In postmenopausal women with normal renal function, es trogen replacement therapy decreases cardiovascular mortality by 50%, in part because of similarities in the lipoprotein profile between hea lthy, postmenopausal women, and women with ESRD, we examined the effec ts of estrogen replacement on lipoproteins in 11 postmenopausal women with ESRD. Methods. In a randomized, placebo-controlled crossover stud y (8 week treatment arms) using 2 mg daily of oral, micronized estradi ol, 11 postmenopausal women with ESRD were treated. Neither baseline l ipid nor lipoprotein abnormalities were used as entry criteria for stu dy participation. Results. Blood estradiol levels were 19 +/- 4 with p lacebo and 194 +/- 67 pg/ml (P = 0.024) with estradiol treatment. Tota l HDL cholesterol concentrations increased from 52 +/- 19 mg/dl to 61 +/- 20 mg/dl (16%), with placebo and estradiol treatments, respectivel y (P = 0.002). Apolipoprotein A(1) increased by 24.6% (P = 0.0002) wit h estradiol intervention. HDL2 concentrations were 19 +/- 13 with plac ebo and 24 +/- 16 with estradiol treatment (P = 0.046). There were no differences in total or LDL cholesterol, other lipoprotein fractions i ncluding Lp(a), and triglycerides with 2 mg daily estradiol treatment. No significant side effects were observed. Conclusions. Therefore, us ing standard dosage regimens for estrogen replacement therapy in postm enopausal women with ESRD, HDL cholesterol is increased to an extent t hat would be expected to improve their cardiovascular risk profile. Fu rther studies are needed to assess whether estrogen replacement therap y decreases the incidence or severity of cardiovascular disease in ESR D patients to a similar degree compared with other women.