[Does postmenopausal hormone replacement therapy have a place in treatment of hyperlipidemia?]

Postmenopausal women experience increases in total cholesterol, triglyceride and lipoprotein (a) levels, decreased HDL cholesterol level and a shift in the LDL particle distribution toward a more dense subtype. Postmenopausal hormone substitution lowers LDL cholesterol level by 12-13%, also in women with hyperlipidaemia, and lowers lipoprotein (a) level. The effect on subtype of LDL has been variable in studies to date. The type, dose and mode of administration of the gestagen as well as the choice of oestrogen (conjugated equine oestrogen versus oestradiol) may affect triglyceride and/or HDL cholesterol levels. The first randomised study of postmenopausal hormone substitution in women with cardiovascular disease (Heart and Estrogen/progestin Replacement Study) showed an increase in cardiovascular events during the first year of therapy with a decrease by the fourth year, thus, there was no overall effect. Several new studies including the Women's Health Initiative and the Women's International Study of long Duration Oestrogen after Menopause should have the power to show the effect of postmenopausal hormone substitution on cardiovascular endpoints in primary prevention, however, the results of these studies will not be available for several years.