Oral östrojen replasman tedavisi alan postmenapozal kadınlarda, AOPP (ileri düzey protein peroksidasyonu), malondialdehit ve okside LDL ölçümü ile kardiyovasküler risk tayini
Thesis Type: Expertise In Medicine
Institution Of The Thesis: Gazi University, Tıp Fakültesi, Cerrahi Tıp Bilimleri, Turkey
Approval Date: 2006
Thesis Language: Turkish
Student: TANSEL ÇAKIR
Supervisor: AHMET ERDEM
Abstract:SUMMARY Hormone replacement therapy is used to compensate the lowered natural estrogen in postmenopausal women. The evaluation of the effects of different hormone replacement therapies on serum lipids, lipid and protein peroxidation products will aid to assess the effects of this therapies on cardiovascular system risks. In this study, different hormone replacement therapy protocols were given to postmenopausal women and short-time effects of these regimens on oxidized LDL, MDA, AOPP and other cardiovascular risk markers were evaluated. The study was conducted with 84 voluntary postmenopausal women. The study population was divided into five groups. In the group in which the patients were hysterectomized continuous 0.625 mg conjugated estrogen (Premarin 0.625 mg pill / day) was used for hormone replacement. In the other three groups in which the patients had intact uteruses, the patients were treated with continuous 0.625 mg conjugated estrogen + 2.5 mg medroxyprogesterone acetate (Premelle 2.5 mg pill / day), or 1mg estradiol + 2 mg drospirenon (Angeliq tablet /day), or 20 mg black cohosh extract (Klimadynon tablet, 2 tablets /day). The control group consisted of patients postmenopausal women, matched to other treatment groups for demographic parameters, with no hormone replacement therapy. In all groups, cardiovascular risk markers were evaluated prospectively before treatment and 3 months after the initiation of the treatment. Besides, the percent change of the parameters after the treatment from basal levels was compared between the treatment and control groups. There were no differences between the groups with respect to basal total cholesterol, LDL cholesterol, VLDL cholesterol, HDL cholesterol, total triglyceride, oxidized LDL and MDA levels (p > 0.05). Only, basal AOPP 57levels were significantly different between group of patients having 20 mg black cohosh extract and controls (p=0.029). Total cholesterol and LDL cholesterol levels were significantly decreased as compared to basal levels in all four treatment groups (p 0.05). As a result, the findings that positive effects of estrogens on lipid profile were seen in treatment groups of either only congutated estrogens or 1 mg estradiol plus 2 mg drospirenon; negative effect of estrogens on triglyceride levels were seen only in congutated estrogens group; the decrease in values of oxidized LDL and MDA were seen in only congutated estrogens treatment group; and no significant changes in any cardiovascular risk parameters were seen in the groups containing continous estrogen + progesterone or black cohosh support data to the known antioxidative and antiatherosclerotic effects of estrogens and suggested atherosclerotic and prooxidative effects of progesterones. There is necessity of larger randomised trials to understand the effects of hormone replacement therapy on AOPP. Thus, the finding of better correlation with lipids before and after treatment compared to other oxidative stress markers is promising for routine clinical use in future. The short-term effect of black cohosh on lipid profile was positive but less pronounced than other regimens. The effects of black cohosh on oxidative stress markers were found to be comparable to HRT regimens other than only conjugated estrogens. More studies are needed to assess the long-tern effect of black cohosh on cardiovascular risk markers. 59