Sbarouni E, Kyriakides Z S
2nd Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece. elbee.ath.forthnet.gr.
J Am Coll Cardiol. 1998 Nov;32(5):1244-50. doi: 10.1016/s0735-1097(98)00413-6.
This study sought to compare hormone replacement therapy (HRT), simvastatin and their combination in the management of hypercholesterolemia in postmenopausal women with coronary artery disease (CAD).
Lipid-lowering therapy reduces mortality in hypercholesterolemic women with CAD. In postmenopausal women HRT seems to increase survival, particularly those with ischemic heart disease, and this is partly due to changes in lipid levels.
We studied 16 postmenopausal women with CAD and fasting total cholesterol <200 mg/dl and low-density lipoprotein (LDL) cholesterol <130 mg/dl. We compared HRT (0.625 mg of conjugated estrogen and 2.5 mg of medroxyprogesterone acetate daily) with simvastatin (20 mg daily) and their combination in a randomized, crossover, placebo-controlled study. Each treatment period was 8 weeks long with a 4-week washout interval between treatments.
Simvastatin, HRT and their combination significantly reduced total and LDL cholesterol by 35%, 13%, and 33% and 45%, 20%, and 46%, respectively, compared to placebo (p < 0.001). However, simvastatin and the combination was superior to HRT (p < 0.001), and none of our patients had total cholesterol <180 mg/dl and LDL cholesterol <100 mg/dl on HRT alone. High-density lipoprotein cholesterol was not significantly affected by any of the active treatments, and triglycerides were lower during simvastatin therapy compared to placebo (p < 0.01). Apolipoprotein B was significantly reduced by simvastatin, alone and combined with HRT, by 39% and 35%, respectively, compared to placebo (p < 0.001). Alone and in combination with simvastatin, HRT significantly increased apolipoprotein A-I by 11% and 12%, respectively, compared to placebo (p < 0.05) and decreased lipoprotein (a) by 23% and 33%, respectively, compared to placebo (p < 0.05), whereas simvastatin had no significant effect on either of these parameters.
In hypercholesterolemic postmenopausal women with CAD, HRT exerts beneficial effects on plasma lipids but the levels currently recommended for secondary prevention are not achieved. Hormone replacement therapy combined with simvastatin is well tolerated and extremely effective, as the two therapies seem to be additive.
本研究旨在比较激素替代疗法（HRT）、辛伐他汀及其联合应用对绝经后冠心病（CAD）女性高胆固醇血症的治疗效果。
降脂治疗可降低患有CAD的高胆固醇血症女性的死亡率。在绝经后女性中，HRT似乎可提高生存率，尤其是患有缺血性心脏病的女性，这部分归因于血脂水平的变化。
我们研究了16名绝经后CAD女性，其空腹总胆固醇<200mg/dl且低密度脂蛋白（LDL）胆固醇<130mg/dl。在一项随机、交叉、安慰剂对照研究中，我们比较了HRT（每日0.625mg结合雌激素和2.5mg醋酸甲羟孕酮）、辛伐他汀（每日20mg）及其联合应用的效果。每个治疗期为8周，治疗之间有4周的洗脱期。
与安慰剂相比，辛伐他汀、HRT及其联合应用分别使总胆固醇和LDL胆固醇显著降低35%、13%和33%，以及45%、20%和46%（p<0.001）。然而，辛伐他汀及其联合应用优于HRT（p<0.001），仅接受HRT治疗时，我们的患者中没有总胆固醇<180mg/dl且LDL胆固醇<100mg/dl的情况。高密度脂蛋白胆固醇未受到任何一种活性治疗的显著影响，与安慰剂相比，辛伐他汀治疗期间甘油三酯水平更低（p<0.01）。与安慰剂相比，辛伐他汀单独使用以及与HRT联合使用时，载脂蛋白B分别显著降低39%和35%（p<0.001）。与安慰剂相比，HRT单独使用以及与辛伐他汀联合使用时，分别使载脂蛋白A-I显著升高11%和12%（p<0.05），并使脂蛋白（a）分别降低23%和33%（p<0.05），而辛伐他汀对这两个参数均无显著影响。
在患有CAD的绝经后高胆固醇血症女性中，HRT对血脂有有益作用，但未达到目前推荐的二级预防水平。激素替代疗法与辛伐他汀联合应用耐受性良好且极其有效，因为这两种疗法似乎具有相加作用。
