Hormonal
The addition of medroxyprogesterone acetate (MPA) to estrogen therapy may abrogate the cardiovascular protective effects of estrogen, potentially explaining the negative results in combined HRT trials like HERS and WHI.
For women requiring uterine protection, the choice of progestin matters. MPA, commonly used in HRT, may negate the heart-healthy lipid changes caused by estrogen. Women concerned about cardiovascular risk should discuss whether alternative progestins or estrogen-only therapy (if no uterus) are appropriate options.
In support of this idea, in the PEPI trial, CEE caused beneficial effects on LDL and HDL levels that were attenuated by MPA... The negative findings of HERS and one arm of WHI may have been due in part to concomitant use of MPA.
Why this rating
Mixed evidence; some animal studies show MPA does not abrogate protection, while human observational data suggests it attenuates lipid benefits.
Source
Vascular consequences of menopause and hormone therapy: Importance of timing of treatment and type of estrogen
Raghvendra K. Dubey et al. · Cardiovascular Research · 2005
DOI 10.1016/j.cardiores.2004.12.012
More from this paper
- Initiating hormone replacement therapy (HRT) with conjugated equine estrogens (CEE) after established cardiovascular disease or significant years post-menopause fails to provide cardiovascular protection and may increase early adverse events, whereas initiating therapy with estradiol near the time of menopause in healthy women can slow atherosclerosis progression.Good
- Conjugated equine estrogens (CEE) are less effective than endogenous estradiol at inhibiting smooth muscle cell growth and preventing neointima formation due to lower binding affinity and potency at estrogen receptors.Good
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