血脂康和辛伐他汀对高胆固醇血症调脂作用的比较

目的研究血脂康对高胆固醇血症患者的调脂作用并与辛伐他汀比较。方法２８例高胆固醇血症患者随机分为两组，服药前及服药后４、８周测定血脂。结果（１）服药后４周ＴＣ分别降低了２０７％和２２５％（Ｐ值均＜０００１）；血脂康降低血清低密度脂蛋白胆固醇（ＬＤＬＣ）作用与辛伐他汀相似，ＬＤＬＣ水平分别降低了２８２％和３３％（Ｐ值均＜００１）；（２）血脂康明显降低１７４％的血清ＴＧ水平（Ｐ＜００５）；（３）服血脂康和辛伐他汀４周后，载脂蛋白（Ａｐｏ）Ａ１却分别增加了１２７％和１３６％（Ｐ值均＜００１）；ＡｐｏＢ水平均下降了８％左右（Ｐ＜００５）；分别使脂蛋白（ａ）［Ｌｐ（ａ）］水平降低了３１３％（Ｐ＜００１）和２７８％（Ｐ＜００５）；（４）除了治疗８周后Ｌｐ（ａ）水平进一步下降外，两种药物治疗８周后的调脂作用与４周比较无明显差异。结论血脂康能显著降低Ⅱａ和Ⅱｂ型高胆固醇血症患者血清ＴＣ和ＬＤＬＣ，其作用与辛伐他汀相等；血脂康降低ＴＧ作用优于辛伐他汀     

降脂抗栓灵治疗高血脂症及脂肪肝100例临床观察

目的观察降脂抗栓灵治疗高血脂症的疗效及安全性。方法１００例高血脂症患者随机分成两组，第１组８０例，每例服降脂抗栓灵每日９片。第２组２０例，服γ月见草油每日９粒。疗程均为８ｗ。结果治疗８ｗ后与治疗前相比，降脂抗栓灵组，血清高密度脂蛋白胆固醇（ＨＤＬＣ）水平升高１４８％（Ｐ＜０００１）；血清总胆固醇（ＴＣ），低密度脂蛋白胆固醇（ＬＤＬＣ），甘油三酯（ＴＧ），（ＴＣ－ＨＤＬＣ）／ＨＤＬＣ的比值分别下降２４７％，３０６％，３１４％及３１９％（Ｐ均＜０００１）。在γ月见草油组上述指标未见明显改变。在降低血清ＴＣ，ＬＤＬＣ，ＴＧ和（ＴＣ－ＨＤＣＣ）／ＨＤＣＣ比值方面，降脂抗栓灵明显优于γ月见草油（Ｐ＜０００１）；在升高血清ＨＤＣＣ方面，降脂抗栓灵虽优于γ月见草油，但未见统计学差异。结论降脂抗栓灵是一种安全有效而易耐受的血脂调节药。     

血脂康对高脂饮食家兔血管内皮细胞功能的保护作用

目的探讨血脂康对高胆固醇饮食家兔血管内皮细胞功能的保护作用。方法健康纯种新西兰白兔３０只，随机分层分组法分为对照组（普通饲料），高脂组（普通饲料＋１５％胆固醇），治疗组（普通饲料＋１５％胆固醇＋血脂康０８ｇ·ｋｇ－１·ｄ－１），在实验不同阶段，观察各组家兔血清脂质、一氧化氮及血浆内皮素、前列环素、血栓素含量及血管内皮细胞病理形态学改变。结果实验前各组血清总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬＣ）、血浆内皮素（ＥＴ）１、血清一氧化氮（ＮＯ）、血浆血栓素（ＴＸ）Ｂ２及６酮前列腺素（ＰＧ）Ｆ１α等无明显差异。实验１２周，高脂组、血脂康治疗组血清ＴＣ、ＴＧ、ＬＤＬＣ及血浆ＥＴ１、ＴＸＢ２及ＴＸＢ２／６酮ＰＧＦ１α比值明显高于对照组，但治疗组明显低于高脂组（Ｐ值均＜０．０５）；血浆ＮＯ低于对照组（Ｐ＜０．０５），但治疗组高于高脂组（Ｐ＜０．０５）。病理结果显示：血脂康治疗组主动脉、冠状动脉粥样硬化病变及血管内皮细胞损伤明显轻于高脂组。结论血脂康具有明显的调整脂质代谢及保护血管内皮细胞功能的作用。     

冬虫夏草多糖治疗慢性丙型肝炎患者的临床研究

目的研究冬虫夏草多糖（ＣＰ）治疗慢性丙型肝炎的疗效．方法慢性丙型肝炎患者２１例，口服ＣＰ１５ｍＬ，３次／ｄ，连服３ｍｏ，治疗前后检测肝功能、血清肝纤维化标志物外周血Ｔ细胞亚群及ＮＫ活性的变化．结果慢性丙型肝炎患者经ＣＰ治疗后，血清ＡＬＴ（Ｕ／Ｌ，６１±３５ｖｓ３５±１５）及ｒＧＴ（Ｕ／Ｌ，１６９±８５ｖｓ１１８±５２）较治疗前显著降低（Ｐ＜００５）．血清ＨＡ（μｇ／Ｌ，２９３±１０９ｖｓ２１４±９６）、ＰⅢＰ（μｇ／Ｌ，１４３±４８ｖｓ１１４±４２）及ＣⅣ（μｇ／Ｌ，２４５±９８ｖｓ１８８±８７）均较治疗前显著下降（Ｐ＜００１，＜００５及＜００５）；ＣＤ４（３６４％±６６％ｖｓ４１０％±５６％）、ＣＤ４／ＣＤ８（１１４±０４０ｖｓ１４３±０２２）、ＮＫ（１６７％±４６％ｖｓ１９７％±４２％）均较治疗前显著增加（Ｐ＜００１），而ＣＤ８（３２６％±４７％ｖｓ２８９％±３７％）则明显降低（Ｐ＜００５）；血清胆红素略减、清蛋白略增但差异均无显著性．结论冬虫夏草多糖可以增强慢性丙型肝炎患者细胞免疫功能，改善肝功能，并具有一定的抗纤维化作用     

尼尔雌醇替代治疗对绝经后妇女 脂及血流变的影响

目的观察尼尔雌醇替代治疗对绝经后妇女血脂及血液流变学的影响。方法对３６例绝经后妇女用尼尔雌醇进行替代治疗,剂量为每半月２ｍｇ,共６月,最后７ｄ加用安宫黄体酮８于用药前和治疗６月后分别测血脂及血液流变学指标。结果尼尔雌醇替代治疗６月后血总胆固醇（ＴＣ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）、ＴＣ／高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）、ＬＤＬ－Ｃ／ＨＤＬ－Ｃ均明显下降（Ｐ〈０．０１）,ＨＤＬ－Ｃ明显升高（Ｐ〉     

口服L-精氨酸对冠状动脉疾病患者肱动脉内皮功能的改善作用

目的研究口服Ｌ精氨酸对冠心病患者肱动脉流量介导舒张功能（ＦＭＤ）的改善作用。方法采用随机、双盲、安慰剂对照、交叉试验设计，２０例患者平均６２８±９３岁，血压正常，冠状动脉造影证实存在冠状动脉疾病，分别口服Ｌ精氨酸（６７ｇ，３／ｄ）或安慰剂７天，间隔洗脱期７天；用高分辨率血管外超声测定治疗前后肱动脉ＦＭＤ和舌下含服硝酸甘油（０５ｍｇ）后肱动脉非内皮依赖性舒张，用高效液相（ＨＰＬＣ）测定治疗前后血浆Ｌ精氨酸水平的变化。结果口服Ｌ精氨酸１周后，肱动脉ＦＭＤ从１９４％±２６２％升高至６１５％±３０４％（配对ｔ检验：ｔ＝４４０，Ｐ＜０００１，２０例），血浆Ｌ精氨酸水平从８４３６±１５３８μｍｏｌ／Ｌ升高至１４３５６±２２９３μｍｏｌ／Ｌ（ｔ＝１０５０，Ｐ＜０００１，２０例）；安慰剂治疗前后肱动脉ＦＭＤ和血浆Ｌ精氨酸均无明显改变，试验过程中Ｌ精氨酸和安慰剂治疗前后肱动脉对舌下含服硝酸甘油的舒张反应性均无明显改变。结论短期口服Ｌ精氨酸可明显改善冠心病患者肱动脉ＦＭＤ，具有增强患者内皮功能的潜在临床意义。     

妇女血脂水平与性激素变化的关系

目的探讨妇女血脂水平与性激素变化的关系,了解性激素在冠心病发病机制中的作用。方法绝经前、围绝经期、绝经后妇女共６０８例,分别测定雌二醇（Ｅ２）、孕酮（Ｐ）、促卵泡生成素（ＦＳＨ）、黄体生成素（ＬＨ）、血清胆固醇（ＴＣ）、甘油三酯（ＴＧ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）及低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）水平。结果绝经后妇女Ｅ２水平较绝经前期及围绝经期妇女明显下降（Ｐ＜０．０１）,后两者无明显差异（Ｐ＞０．０５）,绝经后与围绝经期妇女的ＦＳＨ及ＬＨ均较绝经前期妇女明显升高（Ｐ＜０．０１）,绝经后期较围绝经期组升高更明显,两者相比有显著差异（Ｐ＜０．０１）。绝经前期与围绝经期妇女的血脂水平无显著差异（Ｐ＞０．０５）,绝经后期与绝经前期相比,ＴＣ、ＴＧ、ＬＤＬ－Ｃ水平升高,ＨＤＬ－Ｃ水平下降（Ｐ＜０．０５）。绝经后妇女Ｅ２与ＴＣ、ＬＤＬ－Ｃ水平呈负相关,与ＨＤＬ－Ｃ水平呈正相关。结论妇女血脂异常改变与体内性激素水平下降有关。     

旋毛虫肌肉期幼虫分泌排泄物中46-58kD抗原诱发小鼠保护性免疫的研究

为探讨旋毛虫肌肉期幼虫分泌排泄物（ＴｓＬ１ＥＳ）中４６５８ｋＤ抗原的保护性免疫作用，本文用该纯化抗原组分加福氏完全佐剂（ＦＣＡ）腹腔注射免疫昆明小鼠３次，继以旋毛虫感染性幼虫３００条攻击感染，感染后第７天计数小鼠肠道成虫数、第３０天肌肉幼虫数和血清抗体ＩｇＧ滴度。结果：４６５８ｋＤ抗原免疫鼠的肠道成虫减虫率、肌肉幼虫减虫率和血清抗体ＩｇＧ的几何平均倒数滴度分别为４１８％、４６１％和２８４１２；与ＴｓＬ１ＥＳ诱导的保护性免疫力（４８３％、５０２％和３４５８６）水平接近；显著高于佐剂对照组（４８％、８３％和７４８６）。表明：ＴｓＬ１ＥＳ中４６５８ｋＤ抗原组分可产生明显的保护性免疫作用     

甘油三酯／高密度脂蛋白胆固醇比值对老年冠心病诊断价值的 …

探讨甘油三酯／高密度脂蛋白胆固醇（ＴＧ／ＨＤＬ－Ｃ）比值对老年冠心病（ＣＨＤ）的诊断价值。方法：分极３４２例选择性冠状动脉造影（冠脉造影）确诊的老年ＣＨＤ患者（ＣＨＤ组）及９６例冠脉造影阴性老年人（对照组）的ＴＧ／ＨＤＬ－Ｃ比值水平与ＣＨＤ之间的关系。结果：ＣＨＤ组患者的ＴＧ／ＨＤＬ－Ｃ比值水平及异常率均明显高于对照组（２．５４&;#177;１．２９比１．３２&;#177;１．１６，Ｐ〈０．００１，３５．６％比１３．７％     

肝癌患者外周血树突状细胞免疫功能低下

目的研究肝癌患者外周血树突状细胞（ＤＣ）表面免疫分子ＨＬＡＤＲ及Ｂ７表达水平及其与ＤＣ免疫功能的相关性．方法以健康成人（ｎ＝１０）作为对照，检测临床确诊中晚期肝癌（ＨＣＣ）患者（ｎ＝１０）外周血ＤＣ表面免疫分子ＨＬＡＤＲ及Ｂ７表达水平及ＤＣ免疫诱导Ｔ淋巴细胞增殖的能力．结果ＨＣＣ患者ＤＣ表面ＨＬＡＤＲ及Ｂ７表达水平（ＶＯＦ）为６７±１６及６１±１１，明显低于对照组（１０７±１４及９６±１２，Ｐ＜００５）．其ＤＣ体外诱导Ｔ细胞增殖能力（ｍｉｎ－１）为３１００±１２０，亦明显低于对照组（６２００±９０，Ｐ＜００１）．结论．ＨＣＣ患者ＤＣ表面ＨＬＡＤＲ及Ｂ７表达水平下降，并与ＤＣ免疫功能低下密切相关．     

雌激素替代治疗对绝经后冠心病妇女血脂和胰岛素抵抗的影响

目的 :观察雌激素替代治疗对绝经后冠心病 （CHD）妇女血脂谱和胰岛素抵抗的改善作用。方法 :对确诊为CHD的绝经后妇女 ,口服尼尔雌醇 2 m g/2周 ,治疗 6个月。分别于治疗前后测定血糖、胰岛素 （INS）、性激素结合球蛋白 （SHBG）、促卵泡素 （FSH）、黄体生成素 （L H）、雌二醇 （E2 ）、总胆固醇 （T- CH）、甘油三酯 （TG）、高密度脂蛋白胆固醇 （HDL- C）、低密度脂蛋白胆固醇 （L DL- C）等 ,并计算胰岛素敏感指数 （SI）。结果 :雌激素替代后 ,CHD患者的 FSH,L H,T- CH,TG,L DL- C,INS明显下降 ;而 E2 ,SHBG,HDL- C,SI明显升高。结论 :雌激素替代治疗能改善 CHD患者血脂谱紊乱和胰岛素抵抗     

雌-孕激素替代治疗对绝经后妇女血脂和脂蛋白代谢的长期作用

目的　观察雌 孕激素替代治疗 (HRT)对绝经后妇女血脂和脂蛋白代谢的长期作用。方法　 193例健康绝经后妇女分为A组 (高胆固醇血症组 ) 6 3例、B组 (无高胆固醇血症组 ) 6 0例和C组 (对照组 ) 70例 ,A、B组均给予倍美力 (天然结合型雌激素 ) 0 .6 2 5mg d +安宫黄体酮 2mg d治疗 ,连续 3年监测血清性激素、血脂及脂蛋白水平。结果A组总胆固醇 (TC) ,低密度脂蛋白胆固醇 (LDL C)水平分别下降 12 .1% (P <0 .0 1)、15 .7% (P <0 .0 1) ,B组LDL C下降 4 .5 % (P <0 .0 5 ) ,A、B组高密度脂蛋白胆固醇 (HDL C)水平均明显升高 ,分别为 15 .1% (P <0 .0 1)、2 5 .8% (P <0 .0 1) ,均在第 3个月就出现明显改变 ,并在服药期间可保持疗效 ,对照组则变化不明显。B组TC有下降趋势 ,各组甘油三酯 (TG)均有增高趋势 ,但差异均无显著性意义。A、B组血清 17 β雌二醇 (17 βE2 )和孕酮于第 3个月显著升高 ,血清卵泡刺激素、黄体生成素水平则于第 6个月明显下降 ,并在服药期间可保持疗效 ,而对照组变化不明显。结论　绝经后妇女HRT能改善血清TC、TG、LDL水平 ,并在服药期间可保持疗效 ,对具有高胆固醇血症者效果更佳     

Efficacy of ipriflavone in preventing adverse effects of leuprolide.

The purpose of this study was to evaluate the efficacy of ipriflavone in preventing bone loss, decreasing in serum cholesterol and decreasing the rate of appearance of vasomotor symptoms, as well as the effects of ipriflavone on reduction of myoma volume by estrogen deficiency during treatment with the GnRH analog leuprolide. One hundred two women (mean age, 44.3 +/- 0.53 yr) receiving leuprolide therapy for uterine leiomyoma were randomly allocated to two groups (group A, leuprolide only; group B, leuprolide with ipriflavone). Bone mineral density of the lumbar spine was measured by dual-energy x-ray absorptiometry before and after treatment for 6 months. Levels of serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol (LDL-C) were measured before treatment and after 3 and 6 months of treatment. Subjects were asked to report the appearance of vasomotor symptoms throughout treatment. Myoma node volumes were measured before treatment and after treatment for 6 months. Bone mineral density was reduced in both groups, with reduction rates of -5.26% in group A and -3.70% in group B (P < 0.01 vs. group A). Changes in bone markers were not significant in either group. TC was significantly increased in both groups, and TG levels were increased significantly after 3 and 6 months of treatment in group A but not in group B. There was no significant difference between these two groups in amount of increase of either TC or TG. LDL-C levels were increased significantly after 3 and 6 months of treatment in both groups, and the differences between the groups (11.7% in group A vs. 7.5% in group B at 3 month and 22.6% in group A vs. 8.4% in group B at 6 month) were significant. Severe vasomotor symptoms were reduced in group B. The rates of reduction of myoma volume were 49.8% in group A and 52.9% in group B; this difference between groups was not significant. Ipriflavone efficaciously alleviated the adverse effects of estrogen deficiency such as bone loss and increase in LDL-C level, and the ability of leuprolide therapy to reduce myoma volume was not decreased by ipriflavone administration.     

雌激素替代疗法对绝经后妇女血清血管 紧张素转化酶及血脂代谢的影响

目的　探讨雌激素替代疗法 (ERT)对绝经后妇女血清血管紧张素转化酶 (ACE)含量及血脂代谢的影响。方法　测定 30例健康绝经后妇女应用ERT(治疗组 )前及应用ERT 14周后血清ACE、雌二醇 (E2 )及血清甘油三酯 (TG)、总胆固醇 (TC)、高密度脂蛋白胆固醇 (HDL C)、低密度脂蛋白胆固醇 (LDL C)、脂蛋白 (a) [Lp(a) ]含量 ,并与 30例健康绝经后妇女应用安慰剂 (对照组 )进行对照。结果　对照组应用安慰剂前后 ,ACE及血脂各项含量无变化 ;治疗组应用ERT后 ,ACE含量明显降低且与E2 呈负相关 ,血清TC、LDL C及Lp(a)含量降低 ,HDL C含量升高 ,TG无变化。结论　绝经后妇女补充雌激素 ,可通过降低血清ACE水平及改善血脂代谢共同发挥对心血管系统的保护作用。     

Reduction of fat accumulation and lipid disorders by individualized light aerobic training in human immunodeficiency virus infected patients with lipodystrophy and/or dyslipidemia

BACKGROUND: The management of abdominal fat accumulation and metabolic disorders in HIV1-infected patients, by an aerobic training program, is considered. METHODS: Seventeen lipodystrophic and 2 dyslipidemic (without body modification) adults were studied before and after 4 months of training. The training load was individualized on a ventilatory threshold basis, determined during a maximal exercise test on cycle ergometer. Total (TAT), Visceral (VAT) and Subcutaneous Adipose Tissue (SAT) were assessed by CT-scan. Total (TC) and High Density Lipoprotein (HDL-C) Cholesterol, Triglycerides (TG), lactate (La), insulin and glucose were measured after a 12-hour-overnight fast. LDL, TC/HDL, TG/HDL, HOMA-insulin resistance index and coronary heart disease (CHD) relative risk (RR(CHD)) were calculated. RESULTS: Besides a significant improvement of aerobic fitness, trained patients exhibited a reduction in TAT (-12.8%, p < 0.001), specially at the visceral level (- 12%, p < 0.01) and in TC, TG and La (- 23%, - 43% and - 19% respectively, p < 0.01). HDL-C was increased (+ 6%, p < 0.01). All these effects were above changes that could be expected by a possible regression to the mean artefact. Both TC/HDL and TG/HDL were reduced (p < 0.01) and the estimated RR(CHD) decreased by approximately 13% (p < 0.01). No significant training effect was observed on the 9 available HOMAs. Significant correlations were found between changes in blood lipid values and baseline measures (r range - 0.55 to - 0.79, p < 0.05), indicating a larger improvement when baseline lipid parameters were higher. CONCLUSION: Aerobic training reduced visceral fat, lipid disorders, basal blood lactate and CHD markers in HIV patients. Training effects were particularly important for patients with marked dyslipidemia.     

Mechanisms regulating LDL metabolism in subjects on peroral and transdermal estrogen replacement therapy

To study the mechanisms of low density lipoprotein (LDL) cholesterol lowering by peroral and transdermal estrogen replacement therapy (ERT), 79 hysterectomized postmenopausal women aged 48 to 62 years were randomized in a double-blind double-dummy trial to receive either peroral estradiol valerate (2 mg/d) or transdermal estradiol gel (1 mg/d) for 6 months. Plasma LDL cholesterol decreased from 4. 19+/-0.83 (mean+/-SD) to 3.39+/-0.78 mmol/L (P<0.001) in the peroral group and from 4.11+/-0.86 to 3.72+/-0.78 mmol/L (P<0.001) in the transdermal estrogen group. Peroral estrogen did, but transdermal treatment did not, enhance the fractional catabolic rate (FCR) and production of LDL apolipoprotein B (apoB). However, the decrease of LDL cholesterol was related to an increase in FCR for LDL apoB on both peroral and transdermal ERT (r=-0.645, P<0.001 and r=-0.627, P<0.001, respectively). These changes were associated with changes in the serum estrogen level. Both therapies reduced absorption of dietary cholesterol by 6% to 10% (P<0.05). The effects of estrogen were not modified by the polymorphisms of apoE and apoB or cholesterol 7alpha-hydroxylase. In conclusion, the ERT-induced LDL cholesterol-lowering effect is related to changes in estrogen level, which presumably enhance LDL receptor activity, which is manifested as an increase in FCR for LDL apoB. The small decrease in the absorption efficiency of dietary cholesterol does not seem to contribute largely to the cholesterol lowering on either transdermal or peroral ERT.     

冠心病患者外周血血脂与载脂蛋白A1和载脂蛋白B100水平关系的研究

目的探讨冠心病（CHD）患者外周血脂和载脂蛋白的表达水平及其临床意义。方法选择120例冠心病患者（CHD组）,检测其总胆固醇（TC）、三酰甘油（TC）、低密度脂蛋白胆回醇（LDL—C）、高密度脂蛋白胆固醇（HDL—C）和载脂蛋白A1（APOA1）、载脂蛋白B100（APOB100）的水平,并选择同期健康体检者60名作为健康对照组。结果与对照组相比,冠心病患者外周血TG、TC、LDL—C、APOB100升高,而HDL—C、ApoA1水平下降,差异均有统计学意义（P〈0．05）。CHD组患者HDL—C水平与APOA1水平呈正相关（P〈0．05）,LDL—C水平与APOB100水平亦呈正相关（P〉0．05）。结论冠心病患者外周血脂和载脂蛋白异常,血脂及脂蛋白可作为冠心病患者危险因素的重要指标．联合检测有助于冠心病的早期诊断．     

Oral but not transdermal estrogen replacement therapy changes the composition of plasma lipoproteins

The role of hormone replacement therapy and estrogen replacement therapy (ERT) in cardiovascular disease prevention has not been unambiguously defined yet. The metabolic effects of estrogens may vary depending upon the route of administration. Therefore, we compared the impact of unopposed oral or transdermal ERT on plasma lipids and lipoproteins in 41 hysterectomized women. This was an open-label, randomized, crossover study (with 2 treatments and 2 periods). The 41 hysterectomized women were randomized to receive oral or transdermal 17β-estradiol in the first or second of two 12-week study periods. Plasma lipid and lipoprotein levels were assayed before and after each treatment using standard automated methods. Lipid content of lipoprotein subclasses was assessed by sequential ultracentrifugation. The atherogenic index of plasma (AIP) was calculated as log(triglyceride [TG]/high-density lipoprotein [HDL] cholesterol). The difference between the 2 forms of administration was tested using a linear mixed model. The change from baseline for each of the forms was tested using paired t test. Oral ERT resulted in a significant increase in HDL cholesterol and apolipoprotein A-I levels, whereas it significantly decreased total and low-density lipoprotein (LDL) cholesterol and increased TG concentrations. Transdermal ERT had no such effect. Oral ERT led to a significant TG enrichment of HDL (0.19 ± 0.06 vs 0.27 ± 0.07 mmol/L, P < .001) and LDL particles (0.23 ± 0.08 vs 0.26 ± 0.10 mmol/L, P < .001) compared with baseline, whereas transdermal therapy did not have any effect on lipoprotein subclasses composition. The difference between the 2 treatments was statistically significant for HDL-TG and LDL-TG (0.27 ± 0.07 vs 0.19 ± 0.05 mmol/L, P < .001 and 0.26 ± 0.10 vs 0.22 ± 0.07 mmol/L, P< .001, respectively). The transdermal but not oral ERT significantly reduced the AIP compared with baseline (−0.17 ± 0.26 vs −0.23 ± 0.25, P = .023), making the difference between the therapies statistically significant (−0.23 ± 0.25 vs −0.18 ± 0.22, P = .017). Oral administration of ERT resulted in TG enrichment of LDL and HDL particles. Transdermal ERT did not change the composition of the lipoproteins and produced a significant improvement of AIP. Compared with transdermal ERT, orally administered ERT changes negatively the composition of plasma lipoproteins.     

Enhancement of cholesteryl ester transfer in plasma by hormone-replacement therapy

To study possible mechanisms for the suggested protective effect of hormone-replacement therapy (HRT) with respect to cardiovascular disease we investigated lipoprotein parameters, mass and activity of lipoprotein-metabolizing enzymes, magnitude of postprandial lipemia, and vascular endothelial function in 13 postmenopausal women. All patients were examined before and 3 months after implementation of HRT with estrogen alone (group A, n = 6) or estrogen plus gestagen (group B, n = 7). HRT (groups A and B) resulted in enhanced total transfer of cholesteryl ester (CE) from high-density lipoprotein (HDL) to apolipoprotein B (apoB)-containing lipoproteins (56% +/- 11.45% v 50.82% +/- 13.68%, P <.05) and increased apoA-I plasma concentration (171 +/- 30 v 147 +/- 22 mg/dL, P <.05). Fasting triglycerides (TG) were increased (134 +/- 40 v 115 +/- 39 mg/dL, P <.05). In group A patients the magnitude of postprandial lipemia increased significantly (1,737 +/- 756 v 1,475 +/- 930 mg TG/dL plasma/8 h, P <.05) without any change in lipoprotein lipase (LPL) activity, but with a concomitant decrease in low-density lipoprotein (LDL) size. In both groups flow-mediated dilation (FMD) reflecting vascular endothelial function was not influenced, suggesting that HRT may not directly affect vascular function but rather alters lipoprotein metabolism. The increase of apoA-I was not accompanied by an equivalent rise of HDL cholesterol. Based on the present data this finding can be readily explained by an increase in CE transfer from HDL to TG-rich lipoproteins, which is not due to increased cholesteryl ester transfer protein (CETP) plasma levels, but rather reflects an increase in fasting and postprandial TG. In conclusion, the net effect of accelerated CE transfer due to HRT depends on the balance of proatherogenic aspects, like the generation of small dense LDL, and antiatherogenic aspects, like the stimulation of reverse cholesterol transport.     

Effects of oral and transdermal 17 beta-estradiol combined with progesterone on homocysteine metabolism in postmenopausal women: a randomised placebo-controlled trial

Mild hyperhomocysteinemia is a risk factor for both ischaemic heart disease and venous thromboembolism. The effects of transdermal estrogen replacement therapy (ERT) on homocysteine metabolism in postmenopausal women have scarcely been investigated. This clinical trial aimed to estimate the effects of combined hormone replacement therapy on the fasting total homocysteine levels according to the estrogen route of administration. We enrolled 196 postmenopausal women, who were randomly allocated to receive on a continuous basis either 1mg of 17 beta-estradiol orally (n = 63) or 50 microg transdermally (n = 68) per day, both combined with a daily intake of 100 mg progesterone, or placebo (n = 65) over a period of 6 months. Neither oral nor transdermal ERT significantly affected total plasma homocysteine levels or red-blood cell folate levels. However, oral ERT significantly decreased plasma vitamin B12 levels compared to placebo (mean relative variation difference over 6 months between oral ERT and placebo: -11.7% (95%CI, -21 to -2%) whereas transdermal ERT did not display any significant effects. Our data show that transdermal ERT as well as low dose of oral ERT does not significantly affect the homocysteine metabolism. This finding does not support a role for transdermal estrogen in the prevention of ischaemic heart disease in postmenopausal women.