W. Hanggi et al., LONG-TERM INFLUENCE OF DIFFERENT POSTMENOPAUSAL HORMONE REPLACEMENT REGIMENS ON SERUM-LIPIDS AND LIPOPROTEIN(A) - A RANDOMIZED STUDY, British journal of obstetrics and gynaecology, 104(6), 1997, pp. 708-717
Objective To assess the influence of three different postmenopausal ho
rmone replacement therapies on levels of serum lipids and lipoprotein(
a) [Lp(a)]. Design Open, randomised, controlled study. Participants On
e hundred and forty healthy, early postmenopausal women. Interventions
The women were randomised to receive continuous 17 beta-oestradiol, e
ither orally (2 mg daily; n = 35) or transdermally (50 mu g daily;n =
35), plus 10 mg dydrogesterone daily for 14 days of each 28-day cycle;
or 2.5 mg tibolone daily (n = 35). Thirty-five untreated women acted
as controls. Main outcome measures Fasting blood samples were analysed
at baseline, 6, 12 and 24 months for low-density lipoprotein (LDL)-ch
olesterol, high-density lipoprotein (HDL)-cholesterol, very low densit
y lipoprotein (VLDL), total cholesterol, triglycerides, lipoprotein(a)
[Lp(a)], apolipoproteins A-1, A-2 and B, fibrinogen, and antithrombin
factor III. Results At 24 months oral oestradiol increased mean HDL c
holesterol (7%; 95% CI 1-14), compared with no change in the transderm
al group and a decrease of 26.8% in the tibolone group (95% CI 22.9-30
.5); oral oestradiol decreased mean LDL cholesterol (11.8%; 95% CI 6.3
-19), compared with no change in the tibolone group. Changes in apolip
oprotein A-1 and B showed a similar pattern to HDL and LDL cholesterol
, respectively Oral oestradiol increased serum triglycerides (30%; 95%
CI 18-42) after 24 months, compared with no change in the tibolone an
d transdermal oestradiol groups. Tibolone decreased serum Lp(a) by 36.
6% after 24 months (95% CI 8.3-56.2), oral oestradiol decreased levels
by 29.4% (95% CI 2-51.1), compared with no change in the transdermal
oestradiol group. Conclusions Oral and to a lesser extent transdermal
oestradiol when sequentially combined with dydrogesterone, showed a be
neficial influence on serum lipids regarding the cardiovascular diseas
e risk, which was not seen with tibolone. The significance of Lp(a) le
vels on cardiovascular disease risk remains to be determined.