From the Section on Biostatistics, Bowman Gray School of Medicine of Wake
Forest University, Winston-Salem, NC (M.A.E, C.W.); the Department of
Medicine, University of Washington, Northwest Lipid Research Laboratories,
Seattle (S.M.M); George Washington University Lipid Research Clinic,
Washington, DC (V.M.); the Center for Research in Disease Prevention, Stanford
University, Palo Alto, Calif (P.D.W.); the Department of Epidemiology and
Preventive Medicine, University of Maryland School of Medicine, Baltimore
(T.L.B., R.S.); and the Lipid Research Clinic, University of Iowa, Iowa City
(H.S.).
Correspondence to Mark A. Espeland, PhD, Section on Biostatistics, Bowman Gray School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1063. E-mail mespelan{at}rc.phs.bgsm.edu
Background—Postmenopausal hormone
therapy has been reported to decrease levels of lipoprotein (Lp)(a) in
cross-sectional studies and small or short-term longitudinal studies.
We report findings from a large, prospective, placebo-controlled
clinical trial that allows a broad characterization of these effects
for four regimens of hormone therapy.
Methods and Results—The Postmenopausal Estrogen/Progestin
Interventions study was a 3-year, placebo-controlled, randomized
clinical trial to assess the effect of hormone regimens on
cardiovascular disease risk factors in postmenopausal
women 45 to 65 years of age. The active regimens were conjugated equine
estrogens therapy at 0.625 mg daily, alone or in combination with each
of three regimens of progestational agents:
medroxyprogesterone acetate (MPA) at 2.5 mg daily
(ie, continuous MPA), MPA at 10 mg days 1 to 12 (ie, cyclical MPA), and
micronized progesterone at 200 mg days 1 to 12. Plasma levels of Lp(a)
were measured at baseline (n=366), 12 months (n=354), and 36 months
(n=342). Assignment to hormone therapy resulted in a 17% to 23%
average drop in Lp(a) concentrations relative to placebo
(P<.0001), which was maintained across 3 years of
follow-up. No significant differences were observed among the four
active arms. Changes in Lp(a) associated with hormone therapy were
positively correlated with changes in LDL cholesterol,
total cholesterol, apolipoprotein B, and fibrinogen levels
and were similar across subgroups defined by age, weight, ethnicity,
and prior hormone use.
Conclusions—Postmenopausal estrogen therapy, with or without
concomitant progestin regimens, produces consistent and
sustained reductions in plasma Lp(a) concentrations.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Effect of Postmenopausal Hormone Therapy on Lipoprotein(a) Concentration
Key Words: lipids • lipoproteins • hormones • cardiovascular diseases • risk factors
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