Uticaj terapije estroprogestagenima na lipidni status u menopauzi zavisno od načina primene leka

  • Goran Čitlučanin Outpatient Department “Voždovac”, Belgrade
  • Miomira Ivović Clinical Center of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Diseases
  • Milina Tančić-Gajić Clinical Center of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Diseases
  • Fadil Canović Outpatient Department “Zemun”, Belgrade
  • Miloš Stojanović Clinical Center of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Diseases
  • Ljiljana Marina Clinical Center of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Diseases
  • Zorana Arizanović Clinical Center of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Diseases
  • Aleksandar Djogo Clinical Center Podgorica, Podgorica
  • Svetlana Vujović University of Belgrade, Faculty of Medicine, Belgrade
  • Vladimir Gerginić ; University of Belgrade, Faculty of Medicine, Belgrade
DOI: https://doi.org/10.2298/VSP170318080C
Ključne reči: hormoni, supstituciona terapija;, kardiovaskularne bolesti;, lipidi;, menopauza

Sažetak


Uvod/Cilj. Kod žena u menopauzi, vrednosti lipida i lipoproteina su značajni prediktori razvoja kardiovaskularnih bolesti (KVB). Primena estrogena smanjuje serumske nivoe LDL holesterola (LDL-C) i lipoproteina A [Lp(a)], uz povećanje novoa triglicerida (TG) i HDL holesterola (HDL-C), što zavisi od doze i puta primene leka. Istovremena primena progesterona, zavisno od vrste, može imati različite efekte na novo lipida u serumu. Cilj rada je bio ispitivanje uticaja terapije estroprogestagenima na metabolizam lipida žena u menopauzi, zavisno od puta primene leka. Metode. Istraživanje je sprovedeno po tipu prospektivne kliničke interventne, kontrolisane studije sa paralelnim grupama. Njime su bile obuhvaćene 64 žene u menopauzi, podeljene u tri grupe: grupa 1 (n = 22), na oralnoj terapiji estro­progestagenima, grupa 2 (n = 17) na terapiji transdermalnim flasterima i grupa 3 (n = 25) koja je estroprogestagene primala intramuskularno. U serumu se bili određivani nivoi: ukupnog holesterola (TC), LDL-C, HDL-C, TG, Lp(a), apolipo­pro­teina A (Apo-A) i apolipoproteina B (Apo-B), folikulo­sti­mulirajućeg hormona (FSH), luteinizirajućeg hormona (LH), estradiola, progesterona, testosterona, sex hormone-binding globulin (SHBG), dehidroepiandrosteron sulfata (DHEA-S04), prolaktina i tiroid-stimulišućeg hormona (TSH), i to pre primene hormonske terapije u menopauzi (HTM), kao i posle šest meseca i 2–5 godina od početka terapije. Statistička značajnost razlika u doim vrednostima ispitivana je nezavisno i zavisno od puta primene HTM. Rezultati. HTM, bez obzira na put primene, dovela je do statistički značajnog kontinuiranog sniženja serumskih nivoa TC, LDL-C i Apo-B i kontinuiranog porasta nivoa HDL-C i Apo-A. Vrednosti TC, LDL-C, HDL-C, Lp(a), Apo-A i Apo-B nisu se statistički značajno razlikovale između grupa žena tretiranih HTM, primenjenom na različite načine. Uvrđeno je da s porastom nivoa estradiola u serumu stastistički značajno rastu i serumski novoi Apo-A, dok su serumski nivoi LDL-C i Apo-B bili sniženi bez obzira na put primene HTM. Zaključak. HTM, uvedena na vreme, bez obzira na put primene, ima povoljne efekte na lipidni status žena u menopauzi i posledično mogla bi sprečiti brojne kardiovaskularne bolesti koje su vodeći uzrok smrtnosti.

Biografije autora

Goran Čitlučanin, Outpatient Department “Voždovac”, Belgrade

Primaruis, magistar medicinskih nauka, specijalista opste medicine

Fadil Canović, Outpatient Department “Zemun”, Belgrade

specijalista ginekologije i akuserstva

Svetlana Vujović, University of Belgrade, Faculty of Medicine, Belgrade

Doktor medicinskih nauka, Specijalista interne medicine i endokrinologije, Redovi profesor Medicinskog fakulteta Univerziteta u Beogradu,

Reference

Jouyandeh Z, Nayebzadeh F, Qorbani M, Asadi M. Metabolic syndrome and menopause. J Diabetes Metab Disord 2013; 12(1): 1.

Gravena AA, Brischiliari SC, Lopes TC, Agnolo CM, Carvalho MD, Pelloso SM. Excess weight and abdominal obesity in postmenopausal Brazilian women: a population-based study. BMC Womens Health 2013; 13: 46.

Arthur FK, Adu-Frimpong M, Osei-Yeboah J, Mensah FO, Owusu L. The prevalence of metabolic syndrome and its predominant components among pre-and postmenopausal Ghanaian women. BMC Res Notes 2013; 6: 446.

Vujović S. Menopause. Belgrade: Kosmos; 1998. (Serbian)

Dopsaj V, Šumarac Z. Changes in biochemical parameters in menopause. Arh Farm 2005; 55(2): 76–90. (Serbian)

Gotto AM. Fundamentals of blood lipid metabolism and concepts in atherogenesis. In: Gotto AM, editor. Contemporary Diagnosis and Management of Lipid Disorders. 2nd ed. Pennsylvania, USA: Handbooks in Health Care Co; 2001, p. 27–55.

Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab 2003; 88(6): 2404–11.

Schierbeck LL, Rejnmark L, Tofteng CL, Stilgren L, Eiken P, Mosekilde L, et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomized trial. BMJ 2012; 345: e6409.

Baber RJ, Panay N, Fenton A. IMS Writing Group.2016 IMS Recommendations on women’s midlife health and menopause hormone therapy, Climacteric 2016; 19(2): 109–50.

Jensen J, Nilas L, Christiansen C. Influence of the Menopause on Serum Lipids and Lipoproteins. Maturitas 1990; 12(4): 321–5.

Boardman HM, Hartley L, Eisinga A, Main C, Roqué i Figuls M, Bonfill Cosp X, et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev 2015; (3): CD002229.

The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017; 24(7): 728–53.

Feingold K, Brinton EA, Grunfeld C. The Effect of Endocrine Disorders on Lipids and Lipoproteins. 2017 Feb 24. In: De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, Koch C, et al, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000. Available from: http://www.ncbi.nlm.nih.gov/books/NBK409608/ [Updated 2017 Feb 24].

Coelingh Bennink HJ. Are all estrogens the same? Maturitas 2004; 47(4): 269–75.

Comitato R, Saba A, Turrini A, Arganini C, Virgili F. Sex hormons and macronutritient metabolism. Crit Rev Food Sci Nutr 2015; 55(2): 227–41.

McCarthy JJ. Gene by sex interaction in the etiology of coronary heart disease and the preceding metabolic syndrome. Nutr Metab Cardiovasc Dis 2006; 17(2): 153–61.

Varas-Lorenzo C, Garcia-Rodriguez LA, Perez-Guthann S, Duque-Oliart A. Hormone replacement therapy and incidence of acute myocardial infarction. A population-based nested case-control study. Circulation 2000; 101(22): 2572–8.

Grodstein F, Manson JE, Colditz GA, Willett WC, Speizer FE, Stampfer MJ. A prospective, observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease. Ann Intern Med 2000; 133(12): 933–41.

Omodei U, Boccuti AM, Ruggeri C, Fallo, L. A New HRT Regimen Using Estradiol Valerate and Cyproterone Acetate: Clinical Data. Menopause 1995; 2(4): 270–4.

Mattsson LA, Samsioe G, von Schoultz B, Uvebrant M, Wiklund I. Transdermally administered oestradiol combined with oral medroxyprogesterone acetate: the effects on lipoprotein metabolism in postmenopausal women. Br J Obstet Gynaecol 1993; 100(5): 450–3.

Godsland IF. Effects of postmenopausal hormone replacement therapy on lipid, lipoprotein, and apolipoprotein (a) concentrations: analysis of studies published from 1974-2000. Fertil Steril 2001; 75(5): 898–915.

Krauss MR. Lipids and Lipoproteins and Effects of Hormone Replacement. Chapter 32. In: Lobo RA, editor. Treatment of the Postmenopausal Woman: Basic and Clinical Aspects 2 nd ed. Philadelphia: Lippincott Williams&Wilkins; 1999. p. 461.

Jensen J, Nilas L, Christiansen C. Influence of the Menopause on Serum Lipids and Lipoproteins. Maturitas 1990; 12(4): 321–5.

Soma MR, Meschia M, Bruschi F, Morrisett JD, Paoletti R, Fumagalli R, et al. Hormonal agents used in lowering lipoprotein(a). Chem Phys Lipids 1994; 67–68: 345–50.

Bukowska H, Stanosz S, Zochowska E, Millo B, Sieja K, Chełstowski K, et al. Does the type of hormone replacement therapy affect lipoprotein (a), homocysteine, and C-reactive protein levels in postmenopausal women? Metabolism 2005; 54(1): 72–8.

Walsh BW, Schiff I, Rosner B, Greenberg L, Ravnikar V, Sacks FM. Effects of postmenopausal estrogen replacement on the concentrations and metabolism of plasma lipoproteins. N Engl J Med 1991; 325(17): 1196–204.

Fait T, Vrablík M, Zizka Z, Trnková B, Masata J, Zivný J. Effect of early onset of transdermal and oral estrogen therapy on the lipid profile: a prospective study with cross-over design. Ceska Gynekol 2006; 71(3): 226–30. (Czech)

Camilli A, Di Benedetto L, Camilli FM, Ermini M. The effects of hormone replacement therapy (HRT) on lipid metabolism in the menopause. Minerva Ginecol 1997; 49(5): 199–202. (Italian)

Nanda S, Gupta N, Mehta HC, Sangwan K. Effect of oestrogen replacement therapy on serum lipid profile. Aust N Z J Obstet Gynaecol. 2003; 43(3): 213–6.

Duncan GW, Kirton KT. Depo-Provera: Pharmacology and toxicology. In: Zambrano D, editor. Depo-provera (medro-xyprogesterone acetate) for contraception: A current per-spective of scientific, clinical and social issues. Proceedings of an international symposium held on 19-20 Nov. 1992. Oxford, England: Oxford Clinical Communications; 1992. p. 7– 25.

Hirvonen E, Malkonen M, Manninen V. Effects of Different Progestin on Lipoprotein During Postmenopausal Repla¬ce-ment Therapy. N Engl J Med 1981; 304(10): 500–3.

Anagnostis P, Galanis P, Chatzistergiou V, Stevenson JC, Godsland IF, Lambrinoudaki I, et al. The effect of hormone replacement therapy and tibolone on lipoprotein (a) concentrations in postmenopausal women: A systematic review and meta-analysis. Maturitas 2017; 99: 27–36.

Meschia M, Bruschi F, Soma M, Amicarelli F, Paoletti R, Crosignani P. Effects of oral and transdermal hormone replacement therapy on lipoprotein(A) and lipids: a randomized controlled trial. Menopause 1998; 5(3): 157–62.

Beck KL, Anderson MC, Kirk JK. Transdermal estrogens in the changing landscape of hormone replacement therapy. Postgrad Med 2017; 129(6): 632–6.

Objavljeno
2021/05/21
Broj časopisa
Vol. 77 Br. 4 (2020): Vojnosanit Pregl
Rubrika
Originalni članak