Weintraub M, Grosskopf I, Charach G, Eckstein N, Rubinstein A
Department of Internal Medicine C, the Menopause Clinic, Tel Aviv-Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Metabolism. 1999 Sep;48(9):1193-6. doi: 10.1016/s0026-0495(99)90137-3.
Postmenopausal estrogen therapy reduces cardiovascular morbidity and mortality, except in women with advanced coronary disease. This beneficial effect is partly attributed to a reduction of fasting plasma total and low-density lipoprotein cholesterol (LDL-C) and an elevation of plasma high-density lipoprotein cholesterol (HDL-C) concentrations. Since postprandial lipemia seems to play a role in the pathogenesis of coronary artery disease, we evaluated the effect of hormone replacement therapy (HRT) on postprandial lipoprotein metabolism in 14 normolipemic postmenopausal women. A vitamin A fat-loading test before and after three cycles of treatment with a sequential combination of conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA) was used to label chylomicrons and chylomicron remnants with retinyl palmitate (RP), and RP clearance was assessed over an 8-hour period postprandially. Following 3 months of HRT, fasting total cholesterol and LDL-C levels were reduced 9.8% (P = .049) and 16.5% (P = .023), respectively. Fasting HDL-C levels increased 18.9% (P = .001). Fasting triglycerides (TGs) increased, but not significantly. Postprandial integrated plasma TGs did not change significantly. The integrated RP levels in whole plasma and chylomicron (Svedberg flotation units [Sf] > 1,000) and nonchylomicron (Sf < 1,000) fractions were reduced 58% (P = .043), 78% (P = .041), and 75% (P = .001), respectively, after hormonal treatment. Enhanced clearance of chylomicrons and chylomicron remnants by HRT may contribute to the protective effect of estrogens against cardiovascular disease in normolipemic postmenopausal women.
绝经后雌激素治疗可降低心血管疾病的发病率和死亡率，但患有晚期冠心病的女性除外。这种有益作用部分归因于空腹血浆总胆固醇和低密度脂蛋白胆固醇（LDL-C）的降低以及血浆高密度脂蛋白胆固醇（HDL-C）浓度的升高。由于餐后血脂异常似乎在冠状动脉疾病的发病机制中起作用，我们评估了激素替代疗法（HRT）对14名血脂正常的绝经后女性餐后脂蛋白代谢的影响。在使用结合马雌激素（CEE）和醋酸甲羟孕酮（MPA）的序贯组合进行三个周期治疗前后，进行维生素A脂肪负荷试验，用棕榈酸视黄酯（RP）标记乳糜微粒和乳糜微粒残粒，并在餐后8小时内评估RP清除率。经过3个月的HRT，空腹总胆固醇和LDL-C水平分别降低了9.8%（P = 0.049）和16.5%（P = 0.023）。空腹HDL-C水平升高了18.9%（P = 0.001）。空腹甘油三酯（TGs）有所升高，但无显著变化。餐后血浆综合TGs无显著变化。激素治疗后，全血浆以及乳糜微粒（斯维德伯格漂浮单位[Sf] > 1000）和非乳糜微粒（Sf < 1000）部分的综合RP水平分别降低了58%（P = 0.043）、78%（P = 0.041）和75%（P = 0.001）。HRT增强乳糜微粒和乳糜微粒残粒的清除可能有助于雌激素对血脂正常的绝经后女性心血管疾病的保护作用。
