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PROGESTINS HAVE BENEFICIAL LIPID EFFECTS IN HORMONE THERAPY.

Progestins clearly reduce the risk of endometrial cancer in postmenopausal women receiving estrogen replacement therapy, but some argue that progestins (particularly those with androgenic activity) may nullify the cardiovascular benefits of estrogen therapy. A new study seriously challenges this argument.

The Atherosclerosis Risk in Communities study enrolled 4958 postmenopausal women from four communities and determined their lipid profiles and use of hormone therapy. As expected, current users of estrogen therapy had more strongly cardioprotective blood lipid profiles than both former users and nonusers of hormone therapy: they had significantly higher levels of HDL, HDL2, HDL3, and apolipoprotein A-I and lower levels of LDL, lipoprotein(a), apolipoprotein B, fibrinogen, antithrombin III, glucose, and insulin. The concomitant use of progestin did not seem to diminish estrogen's beneficial effects, and it helped reduce one adverse effect of estrogen therapy: hypertriglyceridemia. The progestin most commonly used in this study, medroxyprogesterone, has little androgenic activity.

This large and careful observational study adds weight to the argument that hormone replacement therapy in women with an intact uterus should include progestins, particularly medroxyprogesterone acetate.

— ALK

Published in Journal Watch General Medicine April 27, 1993

Citation(s):

Martin KA; Freeman MW. Postmenopausal hormone-replacement therapy. N Engl J Med 1993 Apr 15 328 1115-1117.

• Medline abstract (Free)

Nabulsi AA et al. Association of hormone-replacement therapy with various cardiovascular risk factors in postmenopausal women. N Engl J Med 1993 Apr 15 328 1069-1075.

• Medline abstract (Free)

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