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October 11, 1993

The Impact of Female Hormone Usage on the Lipid Profile: The Framingham Offspring Study

Author Affiliations

From the Framingham (Mass) Heart Study (Drs Vaziri, Evans, Larson, and Wilson) and the National Heart, Lung, and Blood Institute, Bethesda, Md (Drs Larson and Wilson).

Arch Intern Med. 1993;153(19):2200-2206. doi:10.1001/archinte.1993.00410190036005

Background:  Exogenous female hormone use appears to affect cardiovascular disease risk in both premenopausal and postmenopausal women. The purpose of this study was to evaluate the impact of exogenous female hormone usage on the lipid profile among premenopausal and postmenopausal women.

Methods:  One thousand nine hundred thirty female participants of the Framingham Offspring study comprised the study population. Of the 992 premenopausal subjects, 57 were current oral contraceptive users; among the 938 postmenopausal subjects, 80 were current hormone users. The influence of hormone use on lipid and lipoprotein levels was determined using multivariable linear regression models that adjusted for age, body mass index, smoking, alcohol intake, β-blocker, and diuretic therapy. Adjusted least-squares means were calculated for each lipid and lipoprotein according to female hormone usage and menopausal status.

Results:  In the premenopausal analysis, pooled oral contraceptive use was significantly related to increased levels of total cholesterol, triglycerides, high-density lipoprotein cholesterol and apolipoprotein A-I. Increased estrogen content was inversely associated with low-density lipoprotein cholesterol, and apolipoprotein B levels, while increased progestin content was inversely related to high-density lipoprotein cholesterol and apolipoprotein A-I levels. Among postmenopausal women, use of premarin only was significantly associated with increased high-density lipoprotein cholesterol and apolipoprotein A-I levels. Combination use of premarin and provera was significantly associated with increased apolipoprotein A-I levels; less powerful but still significant associations with increased high-density lipoprotein cholesterol and decreased low-density lipoprotein cholesterol were also observed.

Conclusion:  In this cross-sectional analysis, oral contraceptive use is associated with both favorable and unfavorable lipid alterations with respect to atherogenic risk. Among postmenopausal women, hormone replacement therapy (both premarin only and combined premarin and provera) appears to be associated with favorable effects on the lipid profile.(Arch Intern Med. 1993;153:2200-2206)