Effects of lower doses of conjugated equine estrogens and medroxyprogesterone acetate on plasma lipids and lipoproteins, coagulation factors, and carbohydrate metabolism

Objective: To determine the effects of lower doses of conjugated equine est rogens (CEE) alone or CEE and medroxyprogesterone acetate (MPA) on lipoprot eins, carbohydrate metabolism, and coagulation/fibrinolytic factors. Design: Randomized, double-blind, placebo-controlled study. Setting: Multicenter substudy of the Women's HOPE trial. Patient(s): Seven hundred and forty-nine healthy, postmenopausal women. Intervention(s): Women were randomized to receive the following doses in mi lligrams per day: 0.625 CEE; 0.625 CEE/2.5 MPA; 0.45 CEE; 0.45 CEE/2.5 MPA; 0.45 CEE/1.5 MPA; 0.3 CEE; 0.3 GEE/1.5 MPA; or placebo. Main Outcome Measure(s): Assessment of lipids, lipoproteins, glucose tolera nce, and coagulation/fibrinolytic factors at baseline, cycle 6, and year 1. Result(s): One year of treatment with any of the CEE or CEE/MPA regimens st udied increased high-density lipoprotein cholesterol (HDL-C); the 10% incre ase in HDL-C for the CEE 0.45/MPA 1.5 group was similar to the CEE 0.625/MP A 2.5 group. Low-density lipoprotein cholesterol was significantly reduced in all of the active treatment groups except the CEE 0.3/MPA 1.5 group at c ycle 13. Apolipoprotein A-I and triglyceride levels increased and apolipopr otein B levels decreased in all groups. The lipoprotein (a) level was reduc ed in the CEE 0.45/MPA 2.5, CEE 0.45/MPA 1.5, and CEE 0.625/MPA 2.5 groups. Minimal changes were observed in carbohydrate metabolism for all groups. F ibrinogen and PAI-1 activity decreased and plasminogen activity increased i n all groups. Decreases in antithrombin III and protein S activities were s ignificant for all active treatment groups except the CEE 0.3/MPA 1.5 group . Conclusion(s): Lower doses of CEE and CEE/MPA induce favorable changes in l ipids, lipoproteins, and hemostatic factors with minimal changes in carbohy drate metabolism. (C) 2001 by American Society for Reproductive Medicine.