Effect of postmenopausal hormone therapy on lipoprotein(a) concentration. PEPI Investigators. Postmenopausal Estrogen/Progestin Interventions.
Effect of postmenopausal hormone therapy on lipoprotein(a) concentration. PEPI Investigators. Postmenopausal Estrogen/Progestin Interventions.
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DOI：
10.1161/01.cir.97.10.979
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发表时间：
1998-03
期刊：
影响因子：
37.8
通讯作者：
M. Espeland;S. Marcovina;Valery T. Miller;Peter D. Wood;C. Wasilauskas;Roger Sherwin;Helmut G. Schrott;T. Bush
中科院分区：
文献类型：
--
作者：
M. Espeland;S. Marcovina;Valery T. Miller;Peter D. Wood;C. Wasilauskas;Roger Sherwin;Helmut G. Schrott;T. Bush
背景在横断面研究和小型或短期纵向研究中，绝经后激素治疗已被报道可降低脂蛋白（Lp）（a）水平。我们报告了一项大型、前瞻性、安慰剂对照临床试验的结果，该试验对四种激素治疗方案的这些效应进行了广泛的表征。方法和结果绝经后雌激素/孕激素干预研究是一项为期3年、安慰剂对照、随机临床试验，旨在评估激素方案对45至65岁绝经后妇女心血管疾病危险因素的影响。活性治疗方案为每日0.625 mg结合马雌激素治疗，单独或与三种促孕剂方案中的每一种联合治疗：每日2.5 mg醋酸甲羟孕酮（MPA）（即，连续MPA），第1至12天10 mg MPA（即，周期性MPA）和第1至12天200 mg微粉化孕酮。在基线（n = 366）、12个月（n = 354）和36个月（n = 342）时测量血浆Lp（a）水平。与安慰剂组相比，激素治疗组的Lp（a）浓度平均下降17%-23%（P <0.0001），并在3年的随访中保持不变。在四个活性组中未观察到显著差异。与激素治疗相关的Lp（a）变化与LDL胆固醇、总胆固醇、载脂蛋白B和纤维蛋白原水平的变化呈正相关，并且在按年龄、体重、种族和既往激素使用定义的亚组中相似。结论：绝经后雌激素治疗，伴随或不伴随的孕酮方案，产生一致和持续的血浆Lp（a）浓度降低。
BACKGROUND Postmenopausal hormone therapy has been reported to decrease levels of lipoprotein (Lp)(a) in cross-sectional studies and small or short-term longitudinal studies. We report findings from a large, prospective, placebo-controlled clinical trial that allows a broad characterization of these effects for four regimens of hormone therapy. METHODS AND RESULT The Postmenopausal Estrogen/Progestin Interventions study was a 3-year, placebo-controlled, randomized clinical trial to assess the effect of hormone regimens on cardiovascular disease risk factors in postmenopausal women 45 to 65 years of age. The active regimens were conjugated equine estrogens therapy at 0.625 mg daily, alone or in combination with each of three regimens of progestational agents: medroxyprogesterone acetate (MPA) at 2.5 mg daily (ie, continuous MPA), MPA at 10 mg days 1 to 12 (ie, cyclical MPA), and micronized progesterone at 200 mg days 1 to 12. Plasma levels of Lp(a) were measured at baseline (n = 366), 12 months (n = 354), and 36 months (n = 342). Assignment to hormone therapy resulted in a 17% to 23% average drop in Lp(a) concentrations relative to placebo (P<.0001), which was maintained across 3 years of follow-up. No significant differences were observed among the four active arms. Changes in Lp(a) associated with hormone therapy were positively correlated with changes in LDL cholesterol, total cholesterol, apolipoprotein B, and fibrinogen levels and were similar across subgroups defined by age, weight, ethnicity, and prior hormone use. CONCLUSIONS Postmenopausal estrogen therapy, with or without concomitant progestin regimens, produces consistent and sustained reductions in plasma Lp(a) concentrations.