Effects of hormone replacement therapy on serum lipids in elderly women - A randomized, placebo-controlled trial

Background: Coronary heart disease (CHD) is the leading cause of death amon g older women. In observational studies, the incidence of CHD has been redu ced in postmenopausal women who take hormone replacement therapy (HRT). A l ow serum level of high-density lipoprotein (HDL) cholesterol is one of the risk factors predictive of death from CHD. Objective: To determine the effects of HRT on serum lipid and lipoprotein l evels in elderly women. Design: Randomized, double-blind, placebo-controlled trial. Setting: University research center. Participants: 59 sedentary women 75 years of age or older. Intervention: Participants were assigned to 9 months of oral therapy with p lacebo or conjugated estrogens, 0.625 mg/d, plus trimonthly medroxyprogeste rone acetate, 5 mg/d for 13 days. Measurements: Serum lipid and lipoprotein levels. Results: After 9 months of treatment, women in the HRT group compared with women in the placebo group had decreased low-density lipoprotein cholestero l levels (mean change [+/-SD], -0.47 +/- 0.69 mmol/L [-18.2+/-26.5 mg/dL] v s. -0.06+/-0.32 mmol/L [-2.2 +/-12.2 mg/dL], respectively; between-group di fference, 0.41 mmol/L [95% CI, 0.09 to 0.74 mmol/L], 16 mg/dL [95% CI, 3.5 to 28.5 mg/dL]; P = 0.01) and increased HDL cholesterol levels (mean change , 0.21 +/- 0.27 mmol/L [8.1+/-10.5 mg/dL] vs. 0.06+/-0.11 mmol/L [2.4+/-4.3 mg/dL], respectively; between-group difference, 0.15 mmol/L [CI, 0.008 to 0.29 mmol/L], 5.7 mg/dL [CI, 0.8 to 10.6 mg/dL]; P = 0.02). The observed ch anges were independent of age at menopause onset, baseline lipid values, bo dy weight, waist circumference, percentage body fat, and peak aerobic power . Conclusions: In women 75 years of age or older, HRT improved the lipoprotei n profile to the extent observed previously in younger postmenopausal women . Further studies are needed to evaluate whether these effects protect agai nst CHD in this population.