Hormone replacement therapy and/or lipid-lowering drugs for menopausal women with hypercholesterolaemia

Menopause is associated with an increase in the total cholesterol Level and with unfavourable changes in the lipid profile. The increase in total plas ma cholesterol is associated with a decrease of HDL cholesterol, which is a n important predictor of cardiac events in women, and with an increase in t he plasma levels of LDL cholesterol and of the atherogenic Lp(a). Several s tudies have shown that oral administration of oestrogen and oestrogen-proge stin replacement therapy has a beneficial effect upon the lipid profile, re ducing total and LDL cholesterol and LF(a) and increasing HDL cholesterol l evels. Although these effects may be of importance in the setting of primar y prevention it is not clear whether hormone replacement therapy is effecti ve in reducing cardiovascular events in women with established coronary art ery disease. In contrast, lipid-lowering therapy with statins has been effe ctive in reducing cardiovascular events in women in the setting of secondar y prevention although doubts exist on its use for primary prevention of pos t-menopausal women with mild-to-moderate hypercholesterolaemia. The only st udy to show a cardioprotective effect with these drugs in postmenopausal hy percholesterolaemia women also found that statin therapy is not cost-effect ive in patients with low or moderate cardiovascular risk. Hormone replaceme nt therapy and statins have a different effect on the lipid profile of meno pausal women; statins are more effective in reducing total and LDL choleste rol without affecting Lp(a), which is significantly reduced only by ovarian hormones. Recent data suggest that a combination of oral hormone replaceme nt therapy and statin therapy is more effective than either of the treatmen ts alone in improving the lipid profile of hypercholesterolaemic postmenopa usal women. Therefore, statin therapy is currently the treatment of choice for hypercholesterolaemic women with established coronary artery disease wh ile hormone replacement therapy should be considered as the first-line trea tment for menopausal hypercholesterolaemia. In women whose cholesterol cann ot be significantly reduced by a single therapy with either statins or horm one replacement therapy, association therapy seem to be the treatment of ch oice.