Espeland M A, Marcovina S M, Miller V, Wood P D, Wasilauskas C, Sherwin R, Schrott H, Bush T L
Section on Biostatistics, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27157-1063, USA.
Circulation. 1998 Mar 17;97(10):979-86. doi: 10.1161/01.cir.97.10.979.
Postmenopausal hormone therapy has been reported to decrease levels of lipoprotein (Lp)(a) in cross-sectional studies and small or short-term longitudinal studies. We report findings from a large, prospective, placebo-controlled clinical trial that allows a broad characterization of these effects for four regimens of hormone therapy.
The Postmenopausal Estrogen/Progestin Interventions study was a 3-year, placebo-controlled, randomized clinical trial to assess the effect of hormone regimens on cardiovascular disease risk factors in postmenopausal women 45 to 65 years of age. The active regimens were conjugated equine estrogens therapy at 0.625 mg daily, alone or in combination with each of three regimens of progestational agents: medroxyprogesterone acetate (MPA) at 2.5 mg daily (ie, continuous MPA), MPA at 10 mg days 1 to 12 (ie, cyclical MPA), and micronized progesterone at 200 mg days 1 to 12. Plasma levels of Lp(a) were measured at baseline (n = 366), 12 months (n = 354), and 36 months (n = 342). Assignment to hormone therapy resulted in a 17% to 23% average drop in Lp(a) concentrations relative to placebo (P<.0001), which was maintained across 3 years of follow-up. No significant differences were observed among the four active arms. Changes in Lp(a) associated with hormone therapy were positively correlated with changes in LDL cholesterol, total cholesterol, apolipoprotein B, and fibrinogen levels and were similar across subgroups defined by age, weight, ethnicity, and prior hormone use.
Postmenopausal estrogen therapy, with or without concomitant progestin regimens, produces consistent and sustained reductions in plasma Lp(a) concentrations.
在横断面研究以及小型或短期纵向研究中，据报道绝经后激素疗法可降低脂蛋白（Lp）（a）水平。我们报告了一项大型、前瞻性、安慰剂对照临床试验的结果，该试验对四种激素疗法方案的这些作用进行了广泛的特征描述。
绝经后雌激素/孕激素干预研究是一项为期3年的安慰剂对照随机临床试验，旨在评估激素方案对45至65岁绝经后女性心血管疾病危险因素的影响。活性方案为每日0.625毫克的结合马雌激素疗法，单独使用或与三种孕激素方案中的每一种联合使用：每日2.5毫克的醋酸甲羟孕酮（MPA）（即持续MPA）、第1至12天每日10毫克的MPA（即周期性MPA）以及第1至12天每日200毫克的微粒化孕酮。在基线时（n = 366）、12个月时（n = 354）和36个月时（n = 342）测量血浆Lp（a）水平。与安慰剂相比，接受激素疗法使Lp（a）浓度平均下降了17%至23%（P<0.0001），并且在3年的随访中一直保持。四个活性组之间未观察到显著差异。与激素疗法相关的Lp（a）变化与低密度脂蛋白胆固醇、总胆固醇、载脂蛋白B和纤维蛋白原水平的变化呈正相关，并且在按年龄、体重、种族和既往激素使用情况定义的亚组中相似。
绝经后雌激素疗法，无论是否伴有孕激素方案，均可使血浆Lp（a）浓度持续且稳定地降低。
