Effects of conjugated equine estrogen with and without three different progestogens on lipoproteins, high-density lipoprotein subfractions, and apolipoprotein A-I

Article Abstract:

Many menopausal women take replacement estrogen (a female hormone), and this treatment is associated with beneficial changes in risk factors for coronary artery disease, namely, an increase in levels of high-density lipoprotein (HDL) cholesterol and a decrease in low-density lipoprotein (LDL) cholesterol (lipoproteins are molecules composed of fats and proteins; they carry cholesterol in the blood). Treatment with estrogen only (unopposed estrogen), however, increases the risk of endometrial cancer (of the uterine lining); this appears to be largely prevented if progestogens (another group of female hormones) are taken at the same time. However, some progestogens lead to lower HDL and higher LDL levels, counteracting the favorable cardiovascular benefits of estrogen. To learn more about the effects of estrogens and progestogens on lipoproteins and related substances in postmenopausal women, 28 subjects were given estrogen for three months, then randomly assigned to receive one of three progestogens for the next three months, with blood samples drawn at regular intervals for lipoprotein analysis. The progestogens were: medroxyprogesterone (thought to affect lipoprotein levels less adversely than other progestogens); norethindrone; or norgestrel (high doses of the latter two have been shown to oppose the positive effects of estrogen on lipoprotein levels). Results showed that unopposed estrogen led to a decrease of between 4 percent and 8 percent in total cholesterol levels and a decrease in LDL cholesterol of between 12 percent and 19 percent. HDL cholesterol and apolipoprotein A-I levels were increased. These effects were partly reversed by progestogens: HDL cholesterol and apolipoprotein A-I levels were appreciably reduced in all three groups after these hormones were added. The reduction in LDL cholesterol was less steep with combined hormonal treatment (between 7 percent and 12 percent). No differences were observed among the effects of the three progestogens. The study suggests that the effects of progestogens combined with estrogen replacement therapy were not entirely detrimental to lipoprotein levels and require further study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Hormone therapy, Estrogen, Estrogens, Lipoproteins, Drug therapy, Combination, Combination drug therapy, Blood lipoproteins, Progestational hormones, Synthetic, Progestational agents

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Hypocholesterolemic effects of different bulk-forming hydrophilic fibers as adjuncts to dietary therapy in mild to moderate hypercholesterolemia

Article Abstract:

Coronary heart disease is a life-threatening condition in which the coronary arteries, which supply the heart, are clogged with fatty, cholesterol-rich atherosclerotic plaque. This condition reduces blood flow to the heart, causing pain and cardiac damage, and increases the likelihood of heart attack. Coronary heart disease has been conclusively linked to elevated blood cholesterol levels. Research has shown that decreasing the blood level of cholesterol, particularly the level of low-density lipoprotein cholesterol, reduces the risks of adverse coronary events. It is estimated that up to 36 percent of all adult Americans need medical advice concerning ways to reduce their cholesterol levels. The preferred strategy for reducing cholesterol levels is dietary modification. Patient are advised to substitute cholesterol-rich foods with low-fat and low-cholesterol food items; in cases where dietary therapy does result in lower blood cholesterol levels, drug treatment may be necessary. Two bulk fiber laxatives that have been suggested as useful adjuncts to a low-cholesterol diet are methylcellulose (a man-made fiber) and calcium polycarbophil (a synthetic fiber made from polyacrylate resin). To study the utility of these compounds in reducing cholesterol, 163 male and female subjects with mild to moderate hypercholesterolemia (elevated blood levels of cholesterol) were recruited for participation in a study. Of these, 105 completed 8 weeks of an American Heart Association step I diet (low fat, low cholesterol), which was then augmented with one of the fiber supplements (methylcellulose or calcium polycarbophil), psyllium (a currently used dietary fiber adjunct), or placebo for an additional 8 weeks. Compliance with the diets was 95 percent, and only mild gastrointestinal side effects were observed. Compared with placebo, only the psyllium-containing diet resulted in a reduction of either total cholesterol or low-density lipoprotein cholesterol. Neither methylcellulose nor calcium polycarbophil provided additional benefit in the treatment of mild to moderate hypercholesterolemia when combined with a low-cholesterol diet. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Coronary heart disease, Diet therapy, Hypercholesterolemia, Fiber in human nutrition, Dietary fiber, Psyllium, Methylcellulose, Methyl cellulose

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