Effects of Hormone Replacement Therapy on Serum Lipids in Elderly Women

Effects of Hormone Replacement Therapy on Serum Lipids in Elderly Women

A Randomized, Placebo-Controlled Trial

From Washington University School of Medicine, St. Louis, Missouri.

Abstract

Background: Coronary heart disease (CHD) is the leading cause of death among older women. In observational studies, the incidence of CHD has been reduced in postmenopausal women who take hormone replacement therapy (HRT). A low serum level of high-density lipoprotein (HDL) cholesterol is one of the risk factors predictive of death from CHD.

Objective: To determine the effects of HRT on serum lipid and lipoprotein levels in elderly women.

Design: Randomized, double-blind, placebo-controlled trial.

Setting: University research center.

Participants: 59 sedentary women 75 years of age or older.

Intervention: Participants were assigned to 9 months of oral therapy with placebo or conjugated estrogens, 0.625 mg/d, plus trimonthly medroxyprogesterone acetate, 5 mg/d for 13 days.

Measurements: Serum lipid and lipoprotein levels.

Results: After 9 months of treatment, women in the HRT group compared with women in the placebo group had decreased low-density lipoprotein cholesterol levels (mean change [±SD], −0.47 ± 0.69 mmol/L [−18.2 ± 26.5 mg/dL] vs. −0.06 ± 0.32 mmol/L [−2.2 ± 12.2 mg/dL], respectively; between-group difference, 0.41 mmol/L [95% CI, 0.09 to 0.74 mmol/L], 16 mg/dL [95% CI, 3.5 to 28.5 mg/dL]; P = 0.01) and increased HDL cholesterol levels (mean change, 0.21 ± 0.27 mmol/L [8.1 ± 10.5 mg/dL] vs. 0.06 ± 0.11 mmol/L [2.4 ± 4.3 mg/dL], respectively; between-group difference, 0.15 mmol/L [CI, 0.008 to 0.29 mmol/L], 5.7 mg/dL [CI, 0.8 to 10.6 mg/dL]; P = 0.02). The observed changes were independent of age at menopause onset, baseline lipid values, body weight, waist circumference, percentage body fat, and peak aerobic power.

Conclusions: In women 75 years of age or older, HRT improved the lipoprotein profile to the extent observed previously in younger postmenopausal women. Further studies are needed to evaluate whether these effects protect against CHD in this population.

Article and Author Information

Acknowledgments: The authors thank Debbie Bronder, Kathie Obert, Timothy Meyer, Joseph Wilmot, Jil Yarasheski, and the staff of the General Clinical Research Center for technical assistance.
Grant Support: By a Claude Pepper Older Americans Independence Center Award (grant P01-AG13629) and a General Clinical Research Center grant (5-M01-RR00036) from the National Institutes of Health. Product support was provided by Wyeth-Ayerst Laboratories.
Requests for Single Reprints: Ellen F. Binder, MD, Division of Geriatrics and Gerontology, Washington University School of Medicine, 4488 Forest Park Boulevard, Suite 201, St. Louis, MO 63108; e-mail, ebinder{at}imgate.wustl.edu.
Current Author Addresses: Dr. Binder: Division of Geriatrics and Gerontology, Washington University School of Medicine, 4488 Forest Park Boulevard, Suite 201, St. Louis, MO 63108.
Dr. Williams: Department of Obstetrics and Gynecology, Washington University School of Medicine, 4444 Forest Park Boulevard, Suite 3100, St. Louis, MO 63108.
Dr. Schechtman: Division of Biostatistics, Washington University School of Medicine, Box 8067, 660 South Euclid, St. Louis, MO 63108.
Dr. Jeffe: Division of Health Behavior Research, Washington University School of Medicine, 4444 Forest Park Boulevard, Suite 6700, St. Louis, MO 63108.
Dr. Kohrt: Department of Medicine, Division of Geriatric Medicine, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Box B-179, Denver, CO 80262.
Author Contributions: Conception and design: E.F. Binder, K.B. Schechtman, W.M. Kohrt.
Analysis and interpretation of the data: E.F. Binder, K.B. Schechtman, W.M. Kohrt.
Drafting of the article: E.F. Binder, W.M. Kohrt.
Critical revision of the article for important intellectual content: E.F. Binder, K.B. Schechtman, W.M. Kohrt.
Final approval of the article: E.F. Binder, D.B. Jeffe, K.B. Schechtman, W.M. Kohrt.
Statistical expertise: K.B. Schechtman.
Obtaining of funding: E.F. Binder, W.M. Kohrt.
Administrative, technical, or logistic support: E.F. Binder, D.B. Williams, D.B. Jeffe, W.M. Kohrt.
Collection and assembly of data: E.F. Binder, D.B. Jeffe.