Treating High Cholesterol with Human Identical Hormone Replacement
Therapy
by Paul Hueseman, RPh, PharmD
October 2003
brought to you by Bellevue Pharmacy, a ProjectAWARE
sponsor
Recent clinical studies of hormone replacement therapy have discounted
the cardiovascular benefit that hormone replacement therapy confers
for post-menopausal women. However, these studies, the Women’s
Health Initiative (WHI) study1 and the Heart and Estrogen/Progestin
Replacement Study II (HERS II)2 were done in patients
receiving Premarin and Prempro (combination of Premarin and medroxyprogesterone),
not human-identical hormones.
In addition, neither study was designed to measure the effect of
hormone treatment on cholesterol. Cholesterol has an important part
in the incidence of blocked arteries, or atherosclerosis, resulting
in heart attacks and strokes. The study period on both of these
studies was cut short, therefore long-term cardiovascular benefits,
such as reduced incidence of atherosclerosis and cardiovascular
events, were not evident in the time that was allowed.
While cholesterol is an important part in blocked arteries, it
is also a critical compound for life. It is the basic building material
for cell membranes, bile acids, vitamin D3, and basic hormones such
as pregnenolone, DHEA, progesterone, estrogen, and testosterone.
When deterioration of the reproductive system functions occurs,
such as during menopause, there is a striking decrease in hormone
levels that results.
The human body tries to maintain a normal ratio between different
hormones: DHEA / cortisol, estrogen / progesterone, female / male
hormones. When there is a malfunction in this feedback loop mechanism,
the result is an imbalance in hormones. When the production of hormones
declines, the body will try to correct this problem by increasing
the production of cholesterol since cholesterol is the building
block for hormones.
A similar situation occurs in pregnant women when the female body
requires more hormones to sustain her pregnancy and development
of the baby in the womb. As a result, cholesterol levels are elevated
significantly. 3-4
Although there are no large studies such as WHI and HERS II to
rely upon for evidence of reduced cholesterol with hormone therapy,
there are some small studies that have documented this effect. R.
Arnold Smith, M.D. and his colleague Sergey A. Dzugan, Ph.D. have
reported results of patients with hypercholesterolemia who were
successfully treated by restoring hormone levels to a youthful physiologic
serum level.
This study involved forty-one patients (16 males and 25 females,
ages 25-81) with hypercholesterolemia who were treated with human
identical hormones. The combination of hormones included pregnenolone,
DHEA, estriol, estradiol, estrone, progesterone, and testosterone.
The follow-up period of the study ranged from 2 to 68 months. All
patients responded to hormone therapy. Mean serum total cholesterol
dropped by 25.6%—from 254.6 mg/dL at baseline to 188.8 mg/dL.
Serum LDL (bad cholesterol) decreased by 23.9%—from 158.2
mg/dL at baseline to 120.4 mg/dL. In addition, authors report that
all patients described a significant improvement in the quality
of life. 5
This article identifies possible benefits from human identical
hormone replacement therapy. Clearly there is a role for alternative
treatments for lowering cholesterol. In addition, in this age of
determining benefits versus risks for hormone replacement therapy,
it is very important to research all possible areas of benefit of
hormone replacement therapy and to differentiate human identical
hormone replacement therapy from synthetic and nonhuman-derived
hormones.
References:
- Writing Group for Women’s Health Initiative Investigators.
JAMA 2002;288:321-333.
- Grady D, Herrington D, et al. JAMA 2002;288:49-57
- Erkkola R, Viikari J, Irjala K, et al. One-year follow-up of
lipoprotein metabolism after pregnancy. Biol Res Pregnancy Perinatol
1986;7(2):47-51.
- Loke DF, Viegas OA, Kek LP, et al. Lipid profiles during and
after normal pregnancy. Gynecol Obstet Invest 1991;32(3):144-7.
- Dzugan SA, Smith RA. Treating
high cholesterol by replacing hormones lost to aging. Life
Extension 2003; (Sept):41-48.
For questions and further information, contact Bellevue
Pharmacy.
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