Hormone Replacement and Cardiovascular Risk Factors

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Abstract
Nabulsi et al. (April 15 issue)1 present convincing data that postmenopausal hormone-replacement therapy, whether with estrogen alone or with estrogen and progestin, greatly decreases the risk of cardiovascular disease. In their editorial, Martin and Freeman reiterate what has become almost conventional wisdom -- namely, that replacement therapy with progestins “attenuates [the] beneficial effects of estrogen on lipid levels” and therefore, presumably, may weaken the protective effect of estrogen-replacement therapy against cardiovascular disease2. I should like to cite a number of studies that offer reassurance that progestins probably do not have such a deleterious effect. Two recent studies, one of oral synthetic progestins3 and one of transdermal synthetic progestins,4 found no lowering of serum high-density lipoprotein (HDL) levels, in contrast to three frequently cited papers of a decade or so ago5-7 (two from the same laboratory) that did report such an effect. Another recent study8 reported that oral micronized progesterone does not lower HDL levels. Spagnoli et al.9 showed that synthetic progestogens inhibit atherogenesis in rabbits fed cholesterol (Martin and Freeman also cite this study), and Haarbo et al.10 reported that synthetic progestogens do not inhibit the antiatherogenic effect of estrogen replacement in cholesterol-fed rabbits after ovariectomy.

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