By: Thomas Pickering, MD, DPhil, FRCP, Director of Integrative and Behavioral Cardiology Program
of the Cardiovascular Institute at Mount Sinai School of Medicine, New York.

About one third of post-menopausal women in the United States have high blood cholesterol levels; the National Cholesterol Education Program (NCEP) has recommended that estrogen replacement therapy be considered as a way of bringing these levels down. This study examined the effects of conjugated estrogen (Premarin in a dose of 0.625 milligrams) and Pravastatin, one of the 'statin' class of lipid-lowering drugs. Seventy-six post-menopausal women with high LDL cholesterols (above 150 mg/dl, or 3.88 mmol/L) were given dietary advice and randomly allocated to one of four treatment groups: Premarin, Pravastatin (20 mgs), both, or placebo (inert pills). Treatment was continued for 16 weeks.

Total cholesterol was reduced by 13% by Premarin, 23.7% by Pravastatin, and 25.2% by the combination. Similar changes were seen in LDL cholesterol. HDL cholesterol increased by 22.5% with Premarin, 3.7% with Pravastatin, and 21.2% with the combination. Triglycerides increased by 4.2% with Premarin, decreased by 12.1% with Pravastatin, and by 0.9% with the combination.

Doctor’s comments

Since the estrogen had the greatest beneficial effect on HDL cholesterol, while the Pravastatin produced the greatest improvement in LDL and total cholesterol, these results suggest that combining estrogen and a statin drug may be a very effective way of improving blood lipids in post-menopausal women. Other studies have estimated that estrogens reduce the chances of getting a heart attack by about half, and the results of this study suggest that this can be accounted for by their effect on lipids.

Where it was published

Davidson MH and colleagues. A comparison of estrogen replacement, Pravastatin, and combined treatment for the management of hypercholesterolemia in postmenopausal women. Archives of Internal Medicine 1997;157:1186-92.