Lipid Levels May ID Postmenopausal Women at Risk for Heart Disease on Hormone Therapy

 Postmenopausal women with elevated low-density lipoprotein (LDL) cholesterol who started conjugated equine estrogens (CEE) plus medroxyprogesterone acetate (MPA) faced increased risk for coronary heart disease (CHD), while those with normal LDL cholesterol showed no increased risk. Women already receiving treatment for hyperlipidemia at baseline experienced no additional CHD risk from hormone therapy.

METHODOLOGY

• Researchers conducted a secondary analysis of two double-blind placebo-controlled randomized trials from the Women's Health Initiative to evaluate how baseline cardiometabolic status modified cardiovascular effects of oral menopausal hormone therapy.
• They analyzed data of postmenopausal women aged 50-79 years between 1993 and 1998 at 40 US centers, including 10,739 women with prior hysterectomy and 16,608 women with an intact uterus.
• Women with prior hysterectomy were randomly assigned to receive CEE (0.625 mg/d) or placebo in one trial, and women with an intact uterus were randomly assigned to receive CEE plus MPA (2.5 mg/d) or placebo in another trial. The mean age of women in both trials was about 63 years.
• Cardiometabolic status was assessed by lipid profile, blood pressure, blood glucose, and presence of metabolic syndrome.
• The primary outcome was CHD, and secondary outcomes were stroke, all-cause mortality, and venous thromboembolism. The CEE trial was stopped at a median follow-up of 6.8 years, and the CEE plus MPA trial at a median follow-up of 5.2 years.

TAKEAWAY

• Among women not already treated for high cholesterol in the CEE plus MPA trial, CHD risk increased progressively with higher levels of baseline LDL cholesterol (P-trend = .002), non-high-density lipoprotein (non-HDL) cholesterol (P-trend = .007), and with a higher LDL/HDL cholesterol ratio (P-trend = .008).
• Participants with HDL cholesterol ≥ 60 mg/dL showed somewhat lower CHD risk on CEE alone compared with those with levels < 50 mg/dL (P-trend = .02).
• Women being treated for high cholesterol, high blood pressure, or diabetes did not show any added CHD risk from hormone therapy. Blood pressure, blood glucose, triglycerides, or presence of metabolic syndrome did not modify CHD risk from hormone therapy.
• The risks for stroke and venous thromboembolism were increased with hormone therapy, and these increases did not vary by baseline cardiometabolic status.

IN PRACTICE

"Measurement of blood lipids could assist with tailoring MHT [menopausal hormone therapy] to the women most likely to benefit," the authors of the study wrote.

SOURCE

The study was led by Jacques E. Rossouw, MD, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle. It was published online on July 24 in Obstetrics and Gynecology.

LIMITATIONS

The subgroup analyses were exploratory and some subgroups had limited data with wide CIs. Researchers tested multiple interactions, raising the possibility of chance findings. Only 2 therapies were studied, limiting applicability of findings to other hormone formulations or routes of delivery.

DISCLOSURES

The Women's Health Initiative program received funding from the National Heart, Lung, and Blood Institute, the National Institutes of Health, and the US Department of Health and Human Services. Wyeth Ayerst donated active and placebo study pills. The authors did not report any conflicts of interest.

https://www.medscape.com/viewarticle/lipid-levels-may-help-identify-postmenopausal-women-risk-2026a1000q0b