Lipid and lipoprotein changes in relation to oral contraception and hormonal replacement therapy.

Estrogens and progestins for contraception or hormonal replacement therapy are widely used by practitioners. These steroids have substantial effects on lipids and lipoproteins that appear to be primarily related to chemical structure of the compound, dosage, and a patient's hormonal status. Although the mechanisms by which alterations in lipid and lipoproteins affect atherogenesis are not fully understood, epidemiologic studies clearly associate alterations with risk of coronary heart disease. Attention to these alterations by progestins and estrogens, as well as further research on how these steroids may exert other cardiovascular effects, is important because atherosclerotic heart disease is a major cause of morbidity and mortality for women as they age.