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Hormonal replacement therapy in postmenopausal women: Risk and benefit ratio

The effects of hormonal replacement therapy (HRT) were evaluated in 74 women and 33 postmenopausal healthy controls. A total number of randomly chosen 74 postmenopausal women of mean age 51.4 +/- 4.24 years were exposed to sequential estrogen /progestin treatment consisting of 2 mg 17 beta-estradiol daily in combination with 1 mg norethisteron acetate. All of the examined women were continouosly given one tablet daily for 19.12 +/- 4.79 months. The main objective was to determine the influence of hormonal replacement therapy on lipids, apoproteins, lipoprotein Lp(a) and fibrinolytic markers. There were no statistically significant differences between, the two groups of postmenopausal women regarding their age, body weight and height. During the analysis of risk factors for coronary heart disease, the statistically significant differences were found between current users and non-users of hormonal replacement therapy for total/HDL cholesterol ratio (p < 0.00002), apoprotein A-II (p < 0.001), antithrombin III (p < 0.009), plasminogen (p < 0.001), systolic (p < 0.015) and diastolic blood pressure (p < 0.03). Current users had lower mean total/HDL ratio (5.03 mmol/l : 6.66 mmol/l), antithrombin. III levels (110.66% : 121.52%) and log plasminogen (4.65% : 4.76%), while their Levels of apoprotein A-II were higher (0.64 g/l : 0.49 g/l) than those in non-users. Multiple linear regression analysis showed that the duration of therapy was associated with smoking (p < 0.10), higher plasminogen concentrations (p < 0.0008*), Lower antithrombin III concentrations (p < 0.10), higher LDL cholesterol (p < 0.10) and slower puls rate (p < 0.06). However, the multiple regression analysis revealed the statistically significant correlation at the level of p < 0.05 only with smoking habits and log plasminogen. The duration of hormonal replacement therapy positively correlated with the increase in body mass index in smokers (p < 0.00005), while in non-smokers positive correlation was found with lower antithrombin III (p < 0.03) and higher plasminogen levels (p < 0.0003). The matrix of correlation revealed that the highest observed correlation was the one between the two established risk factors, i.e. total/HDL cholesterol and triglycerides (r = 0.46). These preliminary findings regarding lipid metabolism in postmenopausal women revealed a beneficial cardioprotective effect of hormonal replacement therapy. That therapy, however, did not significantly affect the lipoprotein Lp(a) levels as an independent risk factor for coronary heart disease. In contrast, hormonal replacement therapy induced a "hypercoagulabile state" by decreasing the antitithrombin III and increasing plasminogen concentration, which could be associated with an increased risk for thromboembolic complications.

hormonal replacement therapy; postmenopausal women; risks and benefits

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