Individual and combined effects of estrogen/progestin therapy and lovastatin on lipids and flow-mediated vasodilation in postmenopausal women with coronary artery disease.
Individual and combined effects of estrogen/progestin therapy and lovastatin on lipids and flow-mediated vasodilation in postmenopausal women with coronary artery disease.
复制标题
雌激素/孕激素治疗和洛伐他汀对患有冠状动脉疾病的绝经后妇女的血脂和血流介导的血管舒张的单独和联合影响。
DOI：
10.1016/s0735-1097(99)00128-x
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发表时间：
1999
影响因子：
24
通讯作者：
Morgan,TM
中科院分区：
文献类型：
--
作者：
Herrington,DM;Werbel,BL;Riley,WA;Pusser,BE;Morgan,TM
结论我们试图研究雌激素/阿伐他汀治疗与洛伐他汀对绝经后心脏病妇女血脂和血流介导的血管舒张的单独和联合作用。一项在24名绝经后妇女中进行的交叉试验，其中每名妇女在三个连续的六周治疗期内接受以下药物方案：1）激素替代（口服剂量为0.625 mg/天结合马雌激素和2.5 mg/天醋酸甲羟孕酮）; 2）20 mg洛伐他汀/天和3）激素替代加洛伐他汀。与基线相比，所有三种方案的胆固醇均显著增加（p < 0.05）。在降低LDL方面，洛伐他汀比雌激素/孕激素更有效（p < 0.001），但在升高HDL方面，雌激素/孕激素略有效。激素替代和洛伐他汀方案阻断了雌激素相关的甘油三酯增加。与基线相比，激素替代（单独和与洛伐他汀联合）导致肱动脉血流介导的血管扩张能力（两种方案均为p = 0.01）和曲线下面积（分别为p = 0.016和p = 0.005）增加。扩张百分比是最大的激素替代方案后，而曲线下的面积是最大的激素替代加洛伐他汀后（69%的改善与基线）。CONCLUSIONSIn绝经后妇女冠心病和高脂血症，共轭马雌激素产生显着改善血脂和血管扩张反应，尽管同时给予低剂量的醋酸甲羟孕酮。低剂量洛伐他汀可使LDL降低更多，但血管舒张反应改善较少。雌激素/孕激素加洛伐他汀可通过更大程度地降低LDL/HDL比值和减轻雌激素相关的高脂血症而提供额外的益处。需要更多关于激素替代和还原酶抑制剂联合治疗的安全性和有效性的信息。
OBJECTIVESWe sought to examine the individual and combined effects of estrogen/progestin therapy versus lovastatin on lipids and flow-mediated vasodilation in postmenopausal women with heart disease.BACKGROUNDLittle information is available regarding the relative benefits of estrogen replacement therapy versus reductase inhibitors and the potential utility of their combination as lipid-lowering therapy for postmenopausal women.METHODSWe conducted a randomized, double-blind, crossover trial in 24 postmenopausal women, each of whom received the following drug regimens during three consecutive six-week treatment periods: 1) hormone replacement (oral dose of 0.625 mg/day conjugated equine estrogens and 2.5 mg/day medroxyprogesterone acetate); 2) 20 mg lovastatin/day and 3) hormone replacement plus lovastatin.RESULTSTotal and low density lipoprotein (LDL) cholesterol were significantly lowered and high density lipoprotein (HDL) cholesterol was significantly increased by all three regimens compared with baseline (p < 0.05). Lovastatin was more effective than estrogen/progestin in reducing LDL (p < 0.001), but estrogen/progestin was slightly more effective in increasing HDL. The hormone replacement and lovastatin regimen blocked the estrogen-associated increase in triglycerides. Hormone replacement (alone and with lovastatin) resulted in increases in brachial artery flow-mediated vasodilator capacity (p = 0.01 for both regimens) and the area under the curve (p = 0.016 and p = 0.005, respectively) compared with baseline. Percent dilation was greatest after the hormone replacement regimen, whereas the area under the curve was greatest after hormone replacement plus lovastatin (69% improvement vs. baseline).CONCLUSIONSIn postmenopausal women with coronary disease and hyperlipidemia, conjugated equine estrogen produced significant improvements in lipids and vasodilator responses despite the concurrent administration of low dose medroxyprogesterone acetate. Low dose lovastatin produced greater reductions in LDL, but less dramatic improvements in vasodilator responses. Estrogen/progestin plus lovastatin may provide additional benefits via a greater reduction in the LDL/HDL ratio and attenuation of estrogen-associated hypertriglyceridemia. More information is needed about the safety and efficacy of such combinations of hormone replacement and reductase inhibitor therapy.