June 28, 1993

The Lowering of Lipoprotein[a] Induced by Estrogen Plus Progesterone Replacement Therapy in Postmenopausal Women

Author Affiliations

From the Institue of Pharmacological Sciences (Drs Soma, Paoletti, and Fumagalli and Ms Osnago-Gadda) and the Department of Obstetrics and Gynecology (Drs Meschia and Crosignani), University of Milan (Italy); and the Department of Medicine, Methodist Hospital, Baylor College of Medicine, Houston, Tex (Dr Morrisett).

Arch Intern Med. 1993;153(12):1462-1468. doi:10.1001/archinte.1993.00410120044006

Objective:  To evaluate whether estrogen plus progesterone replacement therapy influences the plasma lipoprotein[a] (Lp[a]) levels in postmenopausal women.

Design:  Fifty-five women who had been menopausal for at least 1 year were followed up for 12 months. Twenty-four subjects served as the control group and 31 subjects served as the therapy group. The therapy consisted of conjugated estrogen (1.25 mg/d) and medroxyprogesterone acetate (10 mg/d for 10 days a month). Blood samples were obtained before the start of therapy and at 6 months and 12 months after therapy. Nine subjects in the therapy group were followed up for an additional year after the treatment was suspended (washout group).

Settings:  All subjects were healthy women (mean age, 52 years) who had natural menopause at least 1 year before the beginning of recruitment. None of the women had received exogenous sex steroids or drugs known to influence lipid and lipoprotein metabolism in the previous 12 months.

Main Results:  In the control group, no change was noted in the plasma Lp[a] concentrations during the study. In the treatment group, the mean plasma Lp[a] concentrations decreased 50% after 6 months (P<.01) and remained at this level 12 months after treatment was started. In the washout group, mean plasma Lp[a] levels tended to return to pretherapy values. In addition, estrogen plus progesterone treatment significantly lowered total cholesterol levels by 15% and low-density lipoprotein cholesterol levels by 30%; it increased high-density lipoprotein cholesterol levels by 19%.

Conclusion:  The results suggest that in estrogen plus progesterone-treated postmenopausal women, the lipid profile is improved not only by lowering low-density lipoprotein cholesterol levels and raising high-density lipoprotein levels, but also by lowering plasma Lp[a] concentrations.(Arch Intern Med. 1993;153:1462-1468)