Sanada M, Nakagawa H, Kodama I, Sakasita T, Ohama K
Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Hiroshima University, Japan.
Metabolism. 2000 Jun;49(6):784-9. doi: 10.1053/meta.2000.6260.
This study compares the effects of long-term hormone replacement therapy on the lipid profile of postmenopausal women with or without hypercholesterolemia, with a comparison of 2 different regimens over a 3-year period. A total of 209 women were enrolled in this prospective, nonrandomized trial. They were classified into 2 groups according to baseline serum levels of total cholesterol and low-density lipoprotein (LDL) cholesterol. The hypercholesterolemic group consisted of 83 subjects with a total cholesterol level of 220 mg/dL or higher and LDL cholesterol 140 mg/dL or higher. The normocholesterolemic group consisted of 126 subjects with normal total and LDL cholesterol levels. Therapy was assigned as follows: 44 subjects in the hypercholesterolemic group and 67 in the normal cholesterol group with a total hysterectomy received conjugated equine estrogen (CEE) 0.625 mg/d, while 39 subjects in the hypercholesterolemic group and 59 in the normal cholesterol group with a physiological menopause received CEE 0.625 mg/d plus medroxyprogesterone acetate 2.5 mg/d. Fasting blood samples were monitored periodically for 3 years. Nine women withdrew from the study. Hormone replacement therapy had a more favorable effect in the hypercholesterolemic group versus the normal cholesterol group by decreasing total and LDL cholesterol, 7.0% and 16.6%, versus the normal cholesterol group, 0.8% and 3.9%. Serum levels of high-density lipoprotein (HDL) cholesterol were increased in both groups (hypercholesterolemic, 14.4%; normal cholesterol group, 26.5%), with the increase being larger in the normal cholesterol group. These changes were similar with both treatments and were maintained over 3 years. Serum levels of triglyceride were also increased in both groups, with the increase being statistically significant only in the group with normal cholesterol levels at baseline. There were no consistently reported side effects of therapy. The effects of postmenopausal hormone replacement therapy, estrogen with or without progestin, on the lipid profile appear to be related to the subject's baseline lipid values. Thus, such therapy may have a more favorable effect on LDL cholesterol in postmenopausal women with hypercholesterolemia, with the beneficial effect being maintained over 3 years.
本研究比较了长期激素替代疗法对绝经后有或无高胆固醇血症女性血脂水平的影响，并在3年期间比较了2种不同治疗方案的效果。共有209名女性参与了这项前瞻性、非随机试验。根据总胆固醇和低密度脂蛋白（LDL）胆固醇的基线血清水平将她们分为2组。高胆固醇血症组由83名受试者组成，其总胆固醇水平为220mg/dL或更高，LDL胆固醇为140mg/dL或更高。正常胆固醇血症组由126名总胆固醇和LDL胆固醇水平正常的受试者组成。治疗分配如下：高胆固醇血症组中的44名受试者和全子宫切除的正常胆固醇组中的67名受试者接受结合马雌激素（CEE）0.625mg/d，而高胆固醇血症组中的39名受试者和生理性绝经的正常胆固醇组中的59名受试者接受CEE 0.625mg/d加醋酸甲羟孕酮2.5mg/d。在3年期间定期监测空腹血样。9名女性退出了研究。与正常胆固醇组相比，激素替代疗法在高胆固醇血症组中对降低总胆固醇和LDL胆固醇有更有利的作用，分别降低了7.0%和16.6%，而正常胆固醇组分别降低了0.8%和3.9%。两组的高密度脂蛋白（HDL）胆固醇血清水平均升高（高胆固醇血症组为14.4%；正常胆固醇组为26.5%），正常胆固醇组的升高幅度更大。两种治疗的这些变化相似，并在3年期间保持。两组的甘油三酯血清水平也升高，仅在基线时胆固醇水平正常的组中升高具有统计学意义。未持续报告治疗的副作用。绝经后激素替代疗法，无论有无孕激素的雌激素，对血脂水平的影响似乎与受试者的基线血脂值有关。因此，这种疗法可能对绝经后高胆固醇血症女性的LDL胆固醇有更有利的作用，且有益效果可维持3年。
