Effects of conjugated equine estrogen with and without three different progestogens on lipoproteins, high-density lipoprotein subfractions, and apolipoprotein A-I.
Abstract: The effects of conjugated equine estrogen and subsequent cyclical progestogen supplementation on lipoprotein and apolipoprotein A-I levels were investigated in three groups of postmenopausal women. Unopposed conjugated equine estrogen (0.625 mg) lowered total cholesterol 4-8% and low-density lipoprotein (LDL) cholesterol 12-19% below pre-treatment levels in all three groups. Levels of high-density lipoprotein (HDL) cholesterol and apolipoprotein A-I were increased 9-13 and 9-18%, respectively, with unopposed estrogen. The increase in HDL cholesterol was mainly due to increases in the high-density lipoprotein2 (HDL2) subfraction. Addition of medroxyprogesterone acetate, norethindrone acetate, or d,l-norgestrel at doses shown previously to provide protection against endometrial hyperplasia reversed some of the beneficial estrogen effects, reducing levels of HDL cholesterol 14-17%, HDL2 cholesterol 22-37%, and apolipoprotein A-I 11-15% from those obtained with unopposed estrogen. The LDL cholesterol levels fell 12-19% with unopposed estrogen but remained 7-12% below baseline when progestogens were added. These observations demonstrate that after 3 months of treatment, all three progestogens reversed some of the favorable effects of unopposed estrogen on lipoproteins but permitted a continued modest reduction in LDL cholesterol.
Publication Date: 1991-02-01 PubMed ID: 1846437DOI: 10.1097/00006250-199102000-00014Google Scholar: Lookup
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- Clinical Trial
- Journal Article
- Randomized Controlled Trial
- Research Support
- U.S. Gov't
- P.H.S.
Summary
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The research article studies the impact of conjugated equine estrogen, a hormone replacement therapy, and three different progestogens on lipoproteins and apolipoprotein A-I levels in postmenopausal women. The findings reveal that these treatments can impact cholesterol levels, with some beneficial effects reversed upon progestogen addition.
Research Methodology and Subjects
- The study focuses on postmenopausal women divided into three groups, each group undergoing treatment involving conjugated equine estrogen and subsequent cyclical progestogen supplementation.
- The progestogens include medroxyprogesterone acetate, norethindrone acetate, or d,l-norgestrel, all of which have been proved to aid against endometrial hyperplasia, a condition that causes the lining of the uterus to thicken.
Impact on Lipoproteins and Apolipoprotein A-I Levels
- Each group went through a regimen involving unopposed conjugated equine estrogen, which was found to lower total cholesterol by 4-8%, and low-density lipoprotein (LDL) cholesterol, often termed ‘bad cholesterol’, by 12-19% below pre-treatment levels.
- High-density lipoprotein (HDL) cholesterol, commonly known as ‘good cholesterol’, and apolipoprotein A-I, a major protein component of HDL, experienced an increase of 9-13% and 9-18%, respectively, with unopposed estrogen.
- The increase in HDL cholesterol was largely due to a boost in the high-density lipoprotein2 (HDL2) subfraction.
Impact of Progestogen Addition
- When any of the three progestogens were added to the treatment, some of the beneficial effects provided by the estrogen were nullified.
- HDL cholesterol, HDL2 cholesterol, and apolipoprotein A-I saw their levels decrease by 14-17%, 22-37%, and 11-15% respectively, from the levels obtained with unopposed estrogen.
- While levels of LDL cholesterol fell by 12-19% with just estrogen, they still remained 7-12% below the baseline with the addition of progestogens.
- The research concludes that after three months of treatment, all three progestogens reversed some of the favorable impacts of unopposed estrogen on lipoproteins but allowed a continued modest reduction in LDL cholesterol.
Cite This Article
APA
Miller VT, Muesing RA, LaRosa JC, Stoy DB, Phillips EA, Stillman RJ.
(1991).
Effects of conjugated equine estrogen with and without three different progestogens on lipoproteins, high-density lipoprotein subfractions, and apolipoprotein A-I.
Obstet Gynecol, 77(2), 235-240.
https://doi.org/10.1097/00006250-199102000-00014 Publication
Researcher Affiliations
- Department of Medicine, George Washington University Medical Center, Washington, DC.
MeSH Terms
- Adult
- Apolipoprotein A-I
- Apolipoproteins A / drug effects
- Cholesterol / blood
- Cholesterol, HDL / drug effects
- Estrogen Replacement Therapy
- Estrogens, Conjugated (USP) / pharmacology
- Female
- Humans
- Lipoproteins / drug effects
- Medroxyprogesterone / analogs & derivatives
- Medroxyprogesterone / pharmacology
- Medroxyprogesterone Acetate
- Menopause / blood
- Menopause / drug effects
- Middle Aged
- Norethindrone / analogs & derivatives
- Norethindrone / pharmacology
- Norethindrone Acetate
- Norgestrel / pharmacology
- Sex Hormone-Binding Globulin / drug effects
Grant Funding
- R01 HL-34996 / NHLBI NIH HHS
Citations
This article has been cited 12 times.- Kim H, Yoo J, Han K, Fava M, Mischoulon D, Park MJ, Jeon HJ. Associations Between Smoking, Alcohol Consumption, Physical Activity and Depression in Middle-Aged Premenopausal and Postmenopausal Women. Front Psychiatry 2021;12:761761.
- Jiang Y, Tian W. The effects of progesterones on blood lipids in hormone replacement therapy. Lipids Health Dis 2017 Nov 21;16(1):219.
- Khan RJ, Stewart CP, Davis SK, Harvey DJ, Leistikow BN. The risk and burden of smoking related heart disease mortality among young people in the United States. Tob Induc Dis 2015;13(1):16.
- Arora S, Jain A, Chitra R. Effects of short-term hormone replacement on atherogenic indices in Indian postmenopausal women. Indian J Clin Biochem 2006 Mar;21(1):41-7.
- Kararigas G, Becher E, Mahmoodzadeh S, Knosalla C, Hetzer R, Regitz-Zagrosek V. Sex-specific modification of progesterone receptor expression by 17β-oestradiol in human cardiac tissues. Biol Sex Differ 2010 Nov 4;1(1):2.
- Campagnoli C, Clavel-Chapelon F, Kaaks R, Peris C, Berrino F. Progestins and progesterone in hormone replacement therapy and the risk of breast cancer. J Steroid Biochem Mol Biol 2005 Jul;96(2):95-108.
- Karas RH, van Eickels M, Lydon JP, Roddy S, Kwoun M, Aronovitz M, Baur WE, Conneely O, O'Malley BW, Mendelsohn ME. A complex role for the progesterone receptor in the response to vascular injury. J Clin Invest 2001 Aug;108(4):611-8.
- Mantel-Teeuwisse AK, Kloosterman JM, Maitland-van der Zee AH, Klungel OH, Porsius AJ, de Boer A. Drug-Induced lipid changes: a review of the unintended effects of some commonly used drugs on serum lipid levels. Drug Saf 2001;24(6):443-56.
- Prescott E, Hippe M, Schnohr P, Hein HO, Vestbo J. Smoking and risk of myocardial infarction in women and men: longitudinal population study. BMJ 1998 Apr 4;316(7137):1043-7.
- Christiansen C. Sex steroids and the cardiovascular system. Osteoporos Int 1997;7 Suppl 1:S8-11.
- Jacobs S, Hillard TC. Hormone replacement therapy in the aged. A state of the art review. Drugs Aging 1996 Mar;8(3):193-213.
- Wood H, Wang-Cheng R, Nattinger AB. Postmenopausal hormone replacement: are two hormones better than one?. J Gen Intern Med 1993 Aug;8(8):451-8.
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