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Progestins and cardiovascular risk markers.

R Sitruk-Ware1

  • 1Department of Endocrinology, St Antoine Hospital, Paris, France. regine@popcbr.rockefeller.edu

Steroids
|December 8, 2000
PubMed
Summary

Different progestins in hormone replacement therapy (HRT) have varying effects on cardiovascular health. Non-androgenic progestins like natural progesterone do not negatively impact lipids or vasomotion, unlike some androgenic derivatives.

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Area of Science:

  • Endocrinology
  • Cardiovascular Pharmacology
  • Hormone Replacement Therapy

Background:

  • Hormone replacement therapy (HRT) often includes progestins, but their class-effect risks are not uniform.
  • Progestins possess diverse pharmacologic properties, influencing their side effect profiles.
  • Cardiovascular risks associated with HRT require nuanced understanding beyond general progestin effects.

Purpose of the Study:

  • To differentiate the cardiovascular effects of various progestins used in HRT.
  • To investigate the impact of different progestins on lipid profiles, vasomotion, and atherosclerosis markers.
  • To clarify whether progestins modify the cardioprotective effects of estrogens.

Main Methods:

  • Review of pharmacologic properties of different progestins (natural progesterone, 19-norprogesterones, 19-nortestosterone derivatives, 17-hydroxyprogesterones).
  • Analysis of animal model studies (female cynomolgous monkey) examining effects on lipids, atherosclerosis, and vasomotor response.
  • Evaluation of human studies on exercise-induced myocardial ischemia.

Main Results:

  • Non-androgenic progestins (natural progesterone, 19-norprogesterones) show neutral effects on lipids and vasomotion.
  • Androgenic progestins (19-nortestosterone derivatives, some 17-hydroxyprogesterones) negatively affect lipids and vasomotion.
  • Medroxyprogesterone acetate (MPA) and norethisterone acetate (NETA) inhibit estrogen's beneficial vascular effects, unlike nomegestrol acetate or natural progesterone.

Conclusions:

  • Not all progestins used in HRT exert similar effects on cardiovascular risk factors or vascular function.
  • Non-androgenic progestins appear to be cardiovascularly neutral or beneficial, preserving estrogen's cardioprotective actions.
  • Further HRT research should utilize diverse progestin regimens to accurately assess cardiovascular outcomes.

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