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A comparison of estrogen replacement, pravastatin, and combined treatment for the management of hypercholesterolemia in postmenopausal women.
Arch Intern Med. 1997 Jun 09; 157(11):1186-92.AI

Abstract

OBJECTIVES

To evaluate and compare the lipid-altering effects of conjugated estrogens and pravastatin, alone and in combination, in postmenopausal women with hypercholesterolemia.

METHODS

This was a double-blind, randomized, placebo-controlled clinical trial with 4 parallel groups. Participants (N = 76) were randomly assigned to receive conjugated estrogens, 0.625 mg/d; pravastatin sodium, 20 mg/d; conjugated estrogens plus pravastatin; or a placebo for 16 weeks.

RESULTS

Primary end points were changes in serum lipid parameters. Among participants treated with conjugated estrogens, levels of non-high density lipoprotein cholesterol (non-HDL-C) (13.0%) and calculated low density lipoprotein cholesterol (LDL-C) (13.5%) decreased, while levels of HDL-C (22.5%) and triglycerides (4.2%) increased. Participants in the pravastatin group achieved reductions of 23.7% and 25.4% in non-HDL-C and calculated LDL-C levels, respectively. Levels of HDL-C increased slightly (3.7%) and triglycerides decreased by 12.1%. Among participants treated with a combination of conjugated estrogens plus pravastatin, the non-HDL-C (-25.2%) and calculated LDL-C (-28.7%) responses were similar to those of the pravastatin group, and the HDL-C response (21.2%) was similar to that observed in the conjugated estrogens group. Triglyceride levels remained similar to baseline (-0.9%) in the combined treatment group.

CONCLUSIONS

Administration of conjugated estrogens resulted in potentially antiatherogenic changes in levels of non-HDL-C, HDL-C, and calculated LDL-C. The HDL-C response to combined treatment was similar to that observed in women taking conjugated estrogens alone, while the non-HDL-C and LDL-C responses to combined treatment were similar to those produced by pravastatin therapy alone. These findings support the position of the National Cholesterol Education Program that estrogen replacement, with a progestin where indicated, should be given consideration as a therapeutic option for the management of hypercholesterolemia in postmenopausal women.

Authors+Show Affiliations

Chicago Center for Clinical Research, Ill, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

9183229

Citation

Davidson, M H., et al. "A Comparison of Estrogen Replacement, Pravastatin, and Combined Treatment for the Management of Hypercholesterolemia in Postmenopausal Women." Archives of Internal Medicine, vol. 157, no. 11, 1997, pp. 1186-92.
Davidson MH, Testolin LM, Maki KC, et al. A comparison of estrogen replacement, pravastatin, and combined treatment for the management of hypercholesterolemia in postmenopausal women. Arch Intern Med. 1997;157(11):1186-92.
Davidson, M. H., Testolin, L. M., Maki, K. C., von Duvillard, S., & Drennan, K. B. (1997). A comparison of estrogen replacement, pravastatin, and combined treatment for the management of hypercholesterolemia in postmenopausal women. Archives of Internal Medicine, 157(11), 1186-92.
Davidson MH, et al. A Comparison of Estrogen Replacement, Pravastatin, and Combined Treatment for the Management of Hypercholesterolemia in Postmenopausal Women. Arch Intern Med. 1997 Jun 9;157(11):1186-92. PubMed PMID: 9183229.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of estrogen replacement, pravastatin, and combined treatment for the management of hypercholesterolemia in postmenopausal women. AU - Davidson,M H, AU - Testolin,L M, AU - Maki,K C, AU - von Duvillard,S, AU - Drennan,K B, PY - 1997/6/9/pubmed PY - 1997/6/9/medline PY - 1997/6/9/entrez SP - 1186 EP - 92 JF - Archives of internal medicine JO - Arch Intern Med VL - 157 IS - 11 N2 - OBJECTIVES: To evaluate and compare the lipid-altering effects of conjugated estrogens and pravastatin, alone and in combination, in postmenopausal women with hypercholesterolemia. METHODS: This was a double-blind, randomized, placebo-controlled clinical trial with 4 parallel groups. Participants (N = 76) were randomly assigned to receive conjugated estrogens, 0.625 mg/d; pravastatin sodium, 20 mg/d; conjugated estrogens plus pravastatin; or a placebo for 16 weeks. RESULTS: Primary end points were changes in serum lipid parameters. Among participants treated with conjugated estrogens, levels of non-high density lipoprotein cholesterol (non-HDL-C) (13.0%) and calculated low density lipoprotein cholesterol (LDL-C) (13.5%) decreased, while levels of HDL-C (22.5%) and triglycerides (4.2%) increased. Participants in the pravastatin group achieved reductions of 23.7% and 25.4% in non-HDL-C and calculated LDL-C levels, respectively. Levels of HDL-C increased slightly (3.7%) and triglycerides decreased by 12.1%. Among participants treated with a combination of conjugated estrogens plus pravastatin, the non-HDL-C (-25.2%) and calculated LDL-C (-28.7%) responses were similar to those of the pravastatin group, and the HDL-C response (21.2%) was similar to that observed in the conjugated estrogens group. Triglyceride levels remained similar to baseline (-0.9%) in the combined treatment group. CONCLUSIONS: Administration of conjugated estrogens resulted in potentially antiatherogenic changes in levels of non-HDL-C, HDL-C, and calculated LDL-C. The HDL-C response to combined treatment was similar to that observed in women taking conjugated estrogens alone, while the non-HDL-C and LDL-C responses to combined treatment were similar to those produced by pravastatin therapy alone. These findings support the position of the National Cholesterol Education Program that estrogen replacement, with a progestin where indicated, should be given consideration as a therapeutic option for the management of hypercholesterolemia in postmenopausal women. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/9183229/A_comparison_of_estrogen_replacement_pravastatin_and_combined_treatment_for_the_management_of_hypercholesterolemia_in_postmenopausal_women_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/157/pg/1186 DB - PRIME DP - Unbound Medicine ER -