Estrogen, progestogens and cardiovascular risk

This paper provides an overview of hormone replacement therapy (HRT) and its relationship to cardiovascular risk factors, based on several recent studies that evaluated risk using lipid and nonlipid parameters. In the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial, which included a placebo group, an unopposed-estrogen group and three different estrogen-progestogen combination groups, high-density lipoprotein (HDL) cholesterol increased in all treatment groups. Women assigned to conjugated equine estrogen (CEE) alone or CEE plus micronized progesterone (MP) had significantly greater HDL increases than did other treatment groups. Also in the PEPI trial, low-density lipoprotein cholesterol decreased 10-15% in all active treatment groups, regardless of the progestogen evaluated. In the nonlipid measurements of the PEPI trial, fibrinogen was reduced in the nonplacebo groups. Carbohydrate metabolism, measured by two-hour postchallenge insulin level, decreased in all groups, including placebo; however, two-hour glucose increased in the CEE plus medroxyprogesterone acetate (cyclic and continuous) groups vs. placebo but was unchanged in CEE alone and CEE plus MP groups. Neither systolic blood pressure nor diastolic blood pressure differed between PEPI groups. Estrogen, with or without progestogen, was associated with a lower weight gain as compared to placebo over the course of the PEPI study. Also discussed in this review are data on oral contraceptive-related cardiovascular risk. Current generations of oral contraceptives have been found to have some deleterious effects on lipids but fewer than those seen with earlier preparations.