Lipoprotein disorders in women: which women are the best candidates for hormone replacement therapy?

OBJECTIVE: To review the data examining hormone replacement therapy (HRT) in the treatment of lipoprotein disorders in women. DATA SOURCE: A MEDLINE search (1975-1995) of the English-language literature was performed to identify pertinent primary literature and review articles. Articles were also identified through bibliographies of selected articles. DATA EXTRACTION: Controlled and uncontrolled studies evaluating the effects of lipoprotein concentrations or coronary risk and the effects of estrogen and HRT on coronary heart disease and lipoprotein concentrations in women were evaluated. Trials pertaining to adverse effects of therapy were also examined. Emphasis was placed on recent clinical trials. DATA SYNTHESIS: The National Cholesterol Education Program's (NCEP's) 1993 report recommends estrogen replacement therapy as a treatment option in postmenopausal women with hyperlipidemia. Recent trials suggesting that triglycerides and highly-density lipoproteins are more closely related to coronary risks in women necessitate an improved understanding of estrogen and progestin's effects of lipoprotein concentrations. A recent trial has clarified the lipoprotein effects of HRT in women with normal lipid concentrations and suggests that beneficial effects on low-density lipoproteins are maintained, although progestins attenuate beneficial changes in high-density lipoproteins and triglyceride elevations persist. The few trials evaluating estrogen use in women with hyperlipidemia suggest a beneficial effect as well. CONCLUSIONS: In the absence of contraindications, postmenopausal women with hyperlipidemia should be offered estrogen replacement therapy as conjugated equine estrogen of 0.625 mg/D. Pending further information. NCEP's recommendations should be followed regarding goals of therapy.

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