Cardiovascular risk markers in hypothalamic amenorrhoea

OBJECTIVE To determine whether women with oestrogen deficiency due to hypot halamic amenorrhoea (HA) would demonstrate a lipid and lipoprotein pattern similar to that seen in menopause with higher total cholesterol (TC), LDL, triglyceride and Lp(a) and lower HDL levels than women with regular menstru al cycles. DESIGN Cross-sectional. PATIENTS Fifty subjects: 21 women with HA and 30 eumenorrhoeic controls (NL ) matched for age, BMI and fat-free mass. MEASUREMENTS Lipid and lipoprotein levels. RESULTS There was a significant difference in Lp(a) levels in the HA group between women with >19% fat intake and those <19% fat intake (352 +/- 231 v s. 116 +/- 62 mg/l, P = 0.006). Percent fat intake was the most significant determinant of Lp(a) levels in HA, accounting for 51% of the variation in Lp(a) levels. Mean HDL levels were higher in the women with HA compared wit h the controls (1.3 +/- 0.3 vs. 1.1 +/- 0.2 mmol/l, P = 0.002). There was n o significant difference between the groups in TC [4.4 +/- 0.9 (HA) vs. 4.1 +/- 0.8 mmol/l (NL), P> 0.05], LDL [2.8 +/- 0.6 (HA) vs. 2.7 +/- 0.7 mmol/ l (NL), P> 0.05], triglycerides [1.8 +/- 0.5 (HA) vs. 1.7 +/- 0.5 mmol/l (N L), P>0.05] or Lp(a) [234 +/- 199 (HA) vs. 247 +/- 222 (NL) mg/l, P>0.05] l evels. CONCLUSION Reduced Lp(a) levels were associated with low dietary fat in wom en with HA. Moreover, in contrast to menopausal oestrogen deficiency, young women with HA and oestrogen deficiency have increased levels of HDL and no increases in TC, LDL and triglycerides. These data suggest that the negati ve effects of oestrogen deficiency on cardiovascular risk factors may be mo dified in women with hypothalamic amenorrhoea.