Menopause is associated with an increase in the total cholesterol level and with unfavourable changes in the lipid profile. The increase in total plasma cholesterol is associated with a decrease of HDL cholesterol, which is an important predictor of cardiac events in women, and with an increase in the plasma levels of LDL cholesterol and of the atherogenic Lp(a). Several studies have shown that oral administration of oestrogen and oestrogen-progestin replacement therapy has a beneficial effect upon the lipid profile, reducing total and LDL cholesterol and Lp(a) and increasing HDL cholesterol levels. Although these effects may be of importance in the setting of primary prevention it is not clear whether hormone replacement therapy is effective in reducing cardiovascular events in women with established coronary artery disease. In contrast, lipid-lowering therapy with statins has been effective in reducing cardiovascular events in women in the setting of secondary prevention although doubts exist on its use for primary prevention of post-menopausal women with mild-to-moderate hypercholesterolaemia. The only study to show a cardioprotective effect with these drugs in postmenopausal hypercholesterolaemic women also found that statin therapy is not cost-effective in patients with low or moderate cardiovascular risk. Hormone replacement therapy and statins have a different effect on the lipid profile of menopausal women; statins are more effective in reducing total and LDL cholesterol without affecting Lp(a), which is significantly reduced only by ovarian hormones. Recent data suggest that a combination of oral hormone replacement therapy and statin therapy is more effective than either of the treatments alone in improving the lipid profile of hypercholesterolaemic postmenopausal women. Therefore, statin therapy is currently the treatment of choice for hypercholesterolaemic women with established coronary artery disease while hormone replacement therapy should be considered as the first-line treatment for menopausal hypercholesterolaemia. In women whose cholesterol cannot be significantly reduced by a single therapy with either statins or hormone replacement therapy, association therapy seem to be the treatment of choice.
|Journal||European Heart Journal, Supplement|
|Publication status||Published - 2000|
- Heart disease
- Hormone replacement therapy
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine