metricas
covid
Buscar en
Clínica e Investigación en Ginecología y Obstetricia
Toda la web
Inicio Clínica e Investigación en Ginecología y Obstetricia Efectos del 17 β-estradiol oral o transdérmico, combinados con acetato de nore...
Información de la revista
Vol. 28. Núm. 7.
Páginas 262-272 (enero 2001)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 28. Núm. 7.
Páginas 262-272 (enero 2001)
Acceso a texto completo
Efectos del 17 β-estradiol oral o transdérmico, combinados con acetato de noretisterona oral secuencial sobre las concentraciones de lipoproteínas séricas
Visitas
6787
L.C. Tejerizo-López, A. Tejerizo-García, M.M. Sánchez-Sánchez, R.M. García-Robles, A. Leiva, J.M. Benavente, A.I. Teijelo, F. Corredera, J.A. Pérez-Escanilla
Servicio de Obstetricia y Ginecología. Hospital Virgen de la Vega. Salamanca. España
Este artículo ha recibido
Información del artículo
Resumen
Objetivo

analizar los efectos de 17 β-estradiol oral frente al transdérmico, administrados ambos con adición secuencial de acetato de noretisterona oral, sobre las concentraciones séricas de lípidos y lipoproteínas en mujeres posmenopáusicas.

Pacientesymétodo

análisis abierto, aleatorio, con grupos de estudio paralelos. Se incluyeron 56 mujeres posmenopáusicas, con problemas propios del climaterio, las cuales por lo demás estaban sanas. De éstas, 45 cumplieron los criterios del estudio. Untotal de 45 mujeres posmenopáusicas fueron distribuidas aleatoriamente para recibir 17 β-estradiolestriol oral o bien 17 β-estradiol transdérmico, junto con la adición cíclica de acetato de noretisterona durante 48 semanas. Las concentraciones séricas de colesterol total, triglicéridos, lipoproteínas de alta densidad(HDL), lipoproteínas de baja densidad (LDL), lipoproteínas de muy baja densidad (VLDL), apolipoproteínas y lipoproteínas (a) fueron determinadas basalmente, después de 46 semanas (fase estrogénica sola) y a las 48 semanas (fase estrogénicoprogestágena) de tratamiento.

Resultados

la terapia oral con estradiol no afectó a las concentraciones de colesterol sérico total durante la fase únicamente estrogénica, pero durante la fase combinada hubo un descenso del 5,29% (p < 0,05) debido a una disminución del 6,89% en los valores decolesterol ligado a lipoproteínas de baja densidad (p < 0,01). La terapia oral también incrementó las concentraciones de triglicéridos séricos en un 14,28% durante la fase únicamente estrogénica (p < 0,05). Durante la fase combinada de terapia transdérmica hubo un descenso del 19,80% en las concentraciones de triglicéridos séricos (p < 0,01) y del 5,92% en los valores de HDL(p < 0,05).El estradiol oral redujo las concentraciones de lipoproteína en un 32,98% durante la fase únicamente estrogénica y en un 36,08% con laadición de acetato de noretisterona (p < 0,01). La terapia transdérmica no tuvo efectos significativos sobre la lipoproteína (a).

Conclusiones

aparte de un descenso menor en las concentraciones de HDL3 en mujeres a las cuales se les estaba administrando 17 β-estradiol transdérmico, la coadministración de progestágenos orales en general mejoró, en vez de empeorar, el perfil de lipoproteínas séricas.

Summary
Objective

to analyse the effects of oral versus transdermal 17 β-oestradiol, both given with the cyclical addition of oral Norethisterone acetate, on serum lipid and lipoprotein levels in postmenopausal women.

Material And Method

Open, randomised parallel study groups, 56 healthy post menopausal women with climacteric complaints were screened. Of these, 45 fulfilled the entry criteria.

The 45 postmenopausal women were randomised to receive either oral 17 β-oestradiol, or transdermal 17 β-oestradiol together with the cyclical addition of Norethisterone for 48 weeks.

Serum levels of total cholesterol, triglycerides, high density lipoproteins (HDL), low density proteins (LDL), very low density lipoproteins (VLDL), apoli-proteins and lipoprotein (a) at baseline, and after 46 weeks (oestrogenic alone phase), and at 48 weeks (oestrogen-progesterone phase) of treatment.

Results

Oral oestradiol therapy did not affect serum total cholesterol levels during the oestrogen alone phase, but during the combined phase there was a 5.29% fall (p<0.05) due to a 6.89% decrease in LDL cholesterol levels (p<0.01). Oral therapy also increased serum triglyceride levels by 14.28% during the oestrogen alone phase (p<0.05). During the combined phase of transdermal therapy, there was a 19.80% fall in serum triglyceride levels (p<0.01) and a 5.29% fall in HDL levels (p<0.05). Oral oestradiol reduced lipoprotein (a) levels by 32.08% during the oestrogen alone phase and by 36.08% with the addition of Norethisterone acetate (p<0.01). Transdermal therapy had no significant effect on lipoprotein (a).

Conclusions

Other than a minor fall in HDL3, women receiving transdermic 17 β-oestradiol in co-administration with oral progesterone generally improved, rather than worsened, the serum lipoprotein profile.

El Texto completo está disponible en PDF
Bibliografía
[1.]
J.J. Arqueros Álvarez, J. Rodríguez Callejo, F.J. Cortejoso Her-nández, P. Mora Cepeda.
Cambios metabólicos en el cli-materio.
pp. 19-41
[2.]
B. Healy.
The Yentl síndrome.
N Engl J Med, 325 (1991), pp. 274-276
[3.]
J. Herrera Peral, E. Villegas Muñoz.
Climaterio: modifica-ciones lipídicas y riesgo cardiovascular.
pp. 147-165
[4.]
American College of Physicians..
Guidelines for counselling postmenopausal women about preventive hormone therapy.
Ann Intern Med, 117 (1992), pp. 1038-1041
[5.]
L. Stevenson, D. Crook, I. Godsland.
influence of age and menopause of serum lipids and lipoproteins in healthy women.
Atherosclerosis, 98 (1993), pp. 83-90
[6.]
S.A. Brow, R. Hutchinson, J. Morrisett.
Plasma lipid, lipopro-tein cholesterol, and apoprotein distribution in selected US communities. The Atherosclerosis Risk in Communities Study.
Arterioscler Thromb, 13 (1993), pp. 1139-1158
[7.]
J.C. Stevenson, D. Crook, I.F. Godslan, B. Lees, M.I. Whitehead.
Oral versus transdermal hormone replacement therapy.
Int J Fertil Menopausal Stud, 38 (1993), pp. 30-35
[8.]
G. Samsoe.
Hormone replacement therapy and cardiovascular disease.
Int J Fertil Menopausal Stud, 38 (1993), pp. 23-29
[9.]
R.A. Lobo, L. Speroff.
International consensus conference on postmenopausal hormone therapy and the cardiovascular system.
Fertil Steril, 62 (1994), pp. 1765-1795
[10.]
J.M. Ramírez Torres, A. Pérez Vicente, F. Gamez Ruiz.
Cli-materio. Patología médica frecuente: HTA, dislipemias y diabetes.
Manejo práctico de las mismas, (1995), pp. 257-278
[11.]
A. Vilariño, A. Tempone, O. Contreras Ortiz.
Hormonas sexuales y riesgo cardiovascular.
pp. 324
[12.]
P. Silverstolpe, A. Gustafson.
Lipid metabolic studies in oo-forectomized women. Effect of three different progesto-gens.
Acta Obstet Gynecol Scand, 88 (1979), pp. 89-95
[13.]
M. Hortland, J. McNamara.
Some atherogenic concomitants of menopause. The Framingham Study.
Am J Epidemiol, 103 (1976), pp. 304-311
[14.]
H. Campos, J. McNamara, P. Wilson.
Differences in low density lipoprotein subfractions and apoproteins in premeno-pausal and postmenopausal women.
J Clin Endocrinol Me-tab, 67 (1988), pp. 30-35
[15.]
G. Berg, H. Halperm, A. Vilariño.
Plasmatic apolipoprotein and lipid composition of lipoprotein in pre and postmenos-pausal women.
Eur Menopause J, 4 (1997), pp. 4-13
[16.]
B. Centerwall.
Premenopausal hysterectomy and cardiovascular disease.
Am J Obstet Gynecol, 139 (1981), pp. 58-61
[17.]
M. Arca, G. Lena Vega, S. Grundy.
Hypercolesterolemia in postmenopausal women.
JAMA, 271 (1994), pp. 453-459
[18.]
G Berg, A. González, A. Vilariño.
Hepatic lipase in postme-nopausal women: correlation with LDL and HDL.
Gynecol Endocrinol, 12 (1998), pp. 8
[19.]
E. Barret-Connor, T. Bush.
Estrogen and coronary heart disease in women.
JAMA, 265 (1991), pp. 1861-1867
[20.]
M. Stampfer, G. Colditz, W. Willet.
Postmenopausal estrogen therapy and cardiovascular disease: ten-year follow-up the Nurses’Health Study.
N Engl J Med, 325 (1991), pp. 756-762
[21.]
S. Heckbert, N. Weiss, T. Koepsell.
Duration of estrogen replacement therapy in relation to the risk of incident myocar-dial infarction in postmenopausal women.
Arch Intern Med, 157 (1997), pp. 1330-1336
[22.]
A. Nabulsi, A.R. Folson, A. White.
Association of hormone-replacement therapy with various cardiovascular risk factor in postmenopausal women. The Atherosclerosis Risk in Communities Study.
N Engl J Med, 328 (1993), pp. 1069-1075
[23.]
B.G. Wreng.
The effect of the estrogen on the female cardiovascular system.
Med J Aus, 156 (1992), pp. 204-208
[24.]
R. Wallentin, U. Larsson Cohn.
Metabolic and hormonal effects of postmenopausal oestrogen replacement treatment II plasma lipids.
Acta Endocrinol, 86 (1977), pp. 597-607
[25.]
T. Bush, L. Cowan, E. Barret Connor.
Estrogen use and all causes mortality: preliminary results from Lipids Research Clinics Program: Follow up study.
JAMA, (1983; v249), pp. 903-906
[26.]
P. Crook, M. Cust, K. Gangar.
Comparison of transdermal and oral estrogen/progestin hormone replacement therapy: effects on serum lipid and lipoprotein.
Am J Obstet Gynecol, 166 (1992), pp. 950-955
[27.]
F. Sack, B. Walsh.
The effect of reproductive hormones on serum lipoprotein: unresolved issues in biology and clinical practice. Multidisciplinary perspective on menopause.
Annals N Y Acad Sci, 592 (1990), pp. 272-285
[28.]
F. Ryjpkema, A. Sander.
Effect of menopausal hormone replacement therapy on serum lipid.
Maturitas, 12 (1990), pp. 259-285
[29.]
C. Spencer, D. Crook, D. Ross, A. Cooper, M. Whitehead, J. Ste-venson.
A randomised comparison of the effects of oral versus transdermal 17 β-estradiol, each combined with sequential oral norethisterone acetate, on serum lipoprotein levels.
Br J Obstet Gynaecol, 106 (1999), pp. 948-953
[30.]
N. Panay, J. Studd.
Tratamiento hormonal sustitutivo e into-lerancia a la progesterona.
pp. 151-167
[31.]
J. Calaf Alsina, M. Guinot Gasull, et al.
Enfermedades cardiovasculares y terapia hormonal sustitutiva.
El Cli-materio, pp. 157-163
[32.]
C. Bengtsson, C. Björkelund, L. Lapidus, L. Lisser.
Associations of serum lipids concentrations and obesity with mortality in women: 20 year follow up of participants in prospective population study in Gothenburg, Sweden.
Br Med J, 307 (1993), pp. 1385-1388
[33.]
E. Farish, C.D. Fletcher, D.M. Hart.
Lipoprotein and apopro-tein levels in postmenopausal women during treatment with norethisterone.
Clin Chim Acta, 159 (1986), pp. 147-151
[34.]
R.B. Barnes, S. Roy, R.A. Lobo.
Comparison of lipid and androgen levels after conjugated estrogen or depo-medroxy-progesterona acetate in postmenopausal women.
Obstet Gy-necol, 66 (1985), pp. 217-219
[35.]
D. Crook, L. Godsland, J. Hull, J. Stevenson.
Hormone replacement therapy with dydrogesterone and 17 beta-oestra-diol: effects on serum lipoproteins and glucose tolerance during 24 mont follow-up.
Br J Obstet Gynaecol, 104 (1997), pp. 298-304
[36.]
M. Van Der Mooren, P. Demacker, C. Thomas, G. Born, R. Ro-lland.
A 2-year study on the beneficial effects of 17 beta-oestradiol-dydrogesteron therapy on serum lipoprotein and Lp(a) in postmenopausal women: no additional unfavourable effects of dydrogesterone.
Eur J Obstet Gynecol, 52 (1993), pp. 117-123
[37.]
E. Farish, M. Rolton, J. Barnes, D. Hart.
Lipoprotein (a) concentrations in postmenopausal women taking norethistero-ne.
BMJ, 303 (1991), pp. 694
[38.]
B. Henderson, R. Ross, R.A. Lobo, M. Pike, T. Mack.
Re-evaluating the role of pregestin therapy after the menopause.
Fertil Steril, 49 (1988), pp. 95-155
[39.]
R. Ross, A. Paganini-Hill, T. Mack, B. Merderson.
Cardiovascular benefits of estrogen replacement therapy.
Am J Obstet Gynecol, 160 (1989), pp. 1301-1306
[40.]
M. Falkerborn, I. Persson, H. Adami.
The risk of acute myocardial infarction after oestrogen and oestrogen-pro-gestogen replacement.
Br J Obstet Gynaecol, 99 (1992), pp. 821-828
[41.]
B. Psaty, S. Heckbert, D. Atkins.
The risk of myocardial infarction associated with combined use of estrogens and pro-gesting in postmenopausal women.
Arch Intern Med, 154 (1994), pp. 1333-1339
[42.]
F. Grodstein, M. Stampfer, J. Manson, G.A. Colditz, W.C. Willet, B. Rosner, et al.
Postmenopausal estrogen and progestin use and the risk of cardiovascular disease.
N Engl J Med, 335 (1996), pp. 453-461
[43.]
F. Grodstein, M. Stampfer, G. Coldtiz, W.C. Willet, J.E. Manson, M. Joffe, et al.
Postmenopausal hormone theraphy and mortality.
N Engl J Med, 336 (1997), pp. 1769-1775
[44.]
E. Farish, C. Fletchet, M. Dagen.
Lipoprotein and apolipopro-tein levels in postmenopausal women on continous oestro-gen/progestogen therapy.
Br J Obstet Gynaecol, 96 (1989), pp. 358-364
[45.]
G. Warnick, J. Albers.
A comprehensive evaluation of the heparin-manganese precipitation procedure for estimating high density lipoprotein cholesterol.
J Lipid Res, 19 (1978), pp. 65-76
[46.]
L. Gidez, G. Miller, M. Burstein, S. Slagle, H. Eder.
Separation and quantitation of subclases of human plasma high density lipoproteins by a simple precipitation procedure.
J Lipid Res, 23 (1982), pp. 1206-1223
[47.]
R. Havel, M. Eder, J. Bragdon.
The distribution and composition of ultracentrifugally-separated lipoproteins in human serum.
J Clin Invest, 34 (1955), pp. 1345-1353
[48.]
J. Mount, E. Kearney, M. Rossenev, B. Slavin.
Immunoturbidi-metric assays for serum apolipoproteins AI, B using Cobas Bio centrifugal analyser.
J Clin Pathol, 41 (1988), pp. 471-474
[49.]
D. Crook, I. Godsland, M. Worthington, C. Felton, A. Proudler, J. Stevenson.
A comparative metabolic study of two low estrogen dose oral contraceptives containing gestodene or desogestrel progestms.
Am J Obstet Gynecol, 169 (1993), pp. 183-189
[50.]
A. Cano Sánchez.
Introducción a la patología cardiovascular en el climaterio.
Congreso Nacional de la Asociación Española para el Estudio de la Menopausia. IV, pp. 1-3
[51.]
The Writing Group for the PEPI Trial..
Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The postmenopausal Estrogen/Progestin Interventions (PEPI) Trial.
JAMA, 273 (1995), pp. 199-208
[52.]
M. Gerharg, P. Ganz.
How do we explain the clinical benefits of estrogen?.
Circulation, 92 (1995), pp. 5-8
[53.]
D. Burch, K. Spowart, D. Jesinger, S. Randall, S. Smith.
A dose-ranging study of the use of cyclical dydrogesterone with continous 17 beta oestradiol.
Br J Obstet Gynaecol, 102 (1995), pp. 243-248
[54.]
J. Jensen, L. Nilas, C. Christiansen.
Cyclic changes in serum cholesterol and lipoproteins following different dose of combined postmenopausal hormone replacement therapy.
Br J Obstet Gynaecol, 93 (1986), pp. 613-618
[55.]
H.H. Newnham.
Oestrogens and atherosclerotic vascular disease lipid factors.
Baillieres Clin Endocrinol Metab, 7 (1993), pp. 61-93
[56.]
M. Gelfand, P. Fugere, F. Bissonnette.
Cardiovascular risk factors during sequentally combined 17-beta oestradiol and dydrogesterone (Femoston): resuits from a one-year study in postmenopausal women.
Maturitas, 26 (1997), pp. 125-132
[57.]
W. Hangqi, K. Lippuner, W. Riesen, P. Jaeger, M. Virkhauser.
Long term influence of different postmenopausal hormone replacement regimens on serum lipids and lipoprotein (a): a ran-domised study.
Br J Obstet Gynaecol, 104 (1997), pp. 708-711
[58.]
Walsh, L. Schiff, B. Rosner, L. Greenberg, V. Raunikar, F. Sacks.
Effects of postmenopausal estrogen replacement on the concentrations and metabolism of plasma lipoproteins.
N Engl J Med, 325 (1991), pp. 1196-1204
[59.]
D. Hunninghake.
Lipid disorders.
Med Clin North Am, 78 (1994), pp. 301-320
[60.]
H. Drexel, F. Amann, J. Beran.
Plasma triglycerides and three lipoprotein cholesterol fractions are independent predictors of the extent of coronary atherosclerosis.
Circulation, 90 (1994), pp. 2230-2235
[61.]
J. Hokanson, M. Austin.
Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based studies.
J Cardiovasc Risk, 3 (1996), pp. 213-219
[62.]
J.L. Dueñas Díez.
Effectividad de las terapias hormonales.
pp. 27-30
[63.]
M. Austin, J. Mokanson, K. Edwards.
Hypertriglyceridemia as a cardiovascular risk factor.
Am J Cardiol, 81 (1998), pp. B7-B12
[64.]
H.N. Ginsberg, I.J. Golberg, et al.
Trastornos del metabolismo de las lipoproteínas.
Harrison. Principios de Medicina Interna. II, 14, pp. 243-244
[65.]
M.A. Whooley, D. Grady, S.R. Cummings, J. Green, N. Wintfeld, C.D. Atkins, et al.
Postmenopausal hormone therapy and mortality [carta].
N Engl J Med, 337: 1389 (1997),
[66.]
T. Bush, E. Barrett-Connor, L. Cowan.
Cardiovascular mortality and non-contraceptive use of estrogen in women: results from the Lipid Research Clinics Program follow-up study.
Circulation, 75 (1987), pp. 1102-1109
[67.]
D.J. Jacobs, I. Mebane, S. Bangdiwala, M. Criqui, H. Tyroler.
High density lipoprotein cholesterol as a predictor of cardiovascular disease mortality in men and women: the follow-up study of tile Lipid Research Clinics Prevalence Study.
Am J Epidemiol, 131 (1990), pp. 3247
[68.]
A. Granfone, H. Campos, J.R. McNamara.
Effects of estrogen replacement on plasma lipoproteins and apolipoproteins in postmenopausal, dislipemic women.
Metabolism, 41 (1992),
[69.]
M.K. Hong, P.A. Romm, K. Reagan, C. Green, C.E. Rackley.
Effects of estrogen replacement therapy on serum lipids value and angiographically defined coronary artery disease in postmenopausal women.
Am J Cardiol, 59 (1992), pp. 176-178
[70.]
M. Stampfer, F. Sack, S. Salvini, W. Willett, C. Hennekens.
A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction.
N Engl J Med, 325 (1991), pp. 373-381
[71.]
R.A. Lobo, M. Notelovitz, L. Bernstein, F. Khan, R. Ross, W. Paul.
Lp(a) lipoprotein: relationship to cardiovascular disease risk factors, exercise, and estrogen.
Am J Obstet Gynecol, 166 (1992), pp. 1182-1190
[72.]
F. Sacks, R. McPherson, B. Walsh.
Effect of postmenopausal estrogen replacement on plasma Lp(a) lipoprotein concentration.
Arch Intern Med, 154 (1994), pp. 1106-1110
[73.]
C. Kim, H. Jang, D. Cho, Y. Min.
Effects of hormone replacement therapy on lipoprotein (a) and lipids in postmenaopau-sal women.
Arterioscler Thromb, 14 (1994), pp. 275-281
[74.]
S. Mendoza, E. Velázquez, A. Osona, T. Hamer, C. Cluek.
Postmenopausal cyclic estrogen-progestin therapy lowers li-poprotein (a.
J Lab Clin Med, 123 (1994), pp. 837-841
[75.]
M. Mimer, M. Sinnott, T. Cooke, A. Kelly, T. McGill, R. Harri-son.
A 2-year study of lipid and lipoprotein changes in postmenopausal women with tibolone and estrogen-proges-tin.
Obstet Gynecol, 87 (1996), pp. 593-599
[76.]
S. Tonstad, L. Ose, C. Gorbitz, O. Djoseland, J. Bard, J. Fruchart.
Efficacy of sequential hormone replacement therapy in the treatment of hypercholesterolaemia among postmeno-pausal women.
J Intern Med, 238 (1995), pp. 39-47
[77.]
C. Haines, T. Chung, A. Chang, J. Masarei, B. Tomlinson, E. Wong.
Effect of oral estradiol and other lipoproteins in postmenopausal women. A randomised, double blind placebo-controlled, cross-over study.
Arch Intern Med, 156 (1996), pp. 866-872
[78.]
S.I. Whitcroft, D. Crook, M.S. Marsh.
Long term effects of oral and transdermal hormone replacement therapies on serum lipid and lipoprotein concentrations.
Obstet Gynecol, 84 (1994), pp. 1-5
[79.]
J. Jensen, C. Christiansen.
Dose-response effects on serum lipids and lipoproteins following combined oestrogen-pro-gestogen therapy in postmenopausal women.
Maturitas, 9 (1987), pp. 259-266
[80.]
A. Murai, T. Miyahara, N. Fujimoto, M. Matzuda, M. Kameyama.
Lp(a) lipoprotein as a risk factor for coronary heart disease and cerebral infarction.
Atherosclerosis, 59 (1986), pp. 199-204
[81.]
J. Heinrich, M. Sandkamp, R. Kokott, M. Schulte, G. Assman.
Relationship of lipoprotein (a) to variables of coagulation and fibrinolysis in a healthy population.
Clin Chem, 37 (1991), pp. 1950-1954
[82.]
R. Schwartzman, I. Cox, J. Poloniecki, R. Crook, C. Seymour, J. Kaski.
Elevated plasma lipoprotein (a) associated with coronary artery disease patients with chronic stable angina pectoris.
J Am Coll Cardiol, 31 (1998), pp. 1260-1266
[83.]
B. Solymoss, M. Marcil, E. Wesolwoska, B. Gilfix, J. Lesperan-ce, A. Campeau.
Relation of coronary artery disease in women aged less tham 60 years of age to the combined elevation of serum lipoprotein (a) and total cholesterol to high density cholesterol ratio.
Am J Cardiol, 72 (1993), pp. 1215-1219
Copyright © 2001. Elsevier España, S.L.. Todos los derechos reservados
Descargar PDF
Opciones de artículo
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos