The EWA (Estrogen in Women with Atherosclerosis) Study: a randomized studyof the use of hormone replacement therapy in women with angiographically verified coronary artery disease. Characteristics of the study population. Effects on lipids and lipoproteins

Objectives. To evaluate the effects of hormone replacement therapy (HRT) on lipids and lipoproteins in postmenopausal women with coronary artery disea se. Setting. In this single-centre, controlled and randomized study taking plac e in a tertiary referral clinic, patients were examined at baseline, and af ter 3 and 12 months. All analyses were performed examiner-blind. Subjects. Postmenopausal women (n = 118) with angiographically verified cor onary artery disease were recruited consecutively from patients referred fo r investigational procedures due to coronary artery disease. Interventions. The women were randomized to HRT, i.e. transdermal applicati on of continuous 17-beta oestradiol with cyclic medroxyprogesterone actetat e tablets every 3rd month for 14 days, or to a control group. Main outcomes. Effects on lipids and lipoproteins. Results. After 3 months of unopposed oestradiol, triglycerides decreased si gnificantly compared to the control group (P = 0.006). Sequential administr ation of medroxyprogesterone caused a decrease in HDL cholesterol (P = 0.01 ), concomitantly with a decrease in ApoA1 lipoproteins (P = 0.007). No othe r changes in lipids or lipoproteins were observed. After 12 months of thera py, no significant differences were observed between the two groups in lipi d or lipoprotein levels. Concomitant statin treatment did not alter the mai n findings. Conclusions. In postmenopausal women with established coronary artery disea se in whom the majority is treated with statins, no additional effect of HR T on lipids or lipoproteins could be observed except for a transient decrea se in triglycerides in the initial unopposed oestradiol phase. No deleterio us effect could be observed during medroxyprogesterone administration excep t for a small transient decrease in HDL cholesterol and ApoA1 lipoproteins.