Maturitas
Volume 54, Issue 2 , Pages 154-163, 20 May 2006

Which progestogen is more likely to increase the risk of fatal myocardial infarction: A combination of epidemiological and trial evidence

  • Farook Al-Azzawi

      Affiliations

    • Gynaecology Research Unit, University Hospitals of Leicester, Leicester LEI 5WW, UK
    • Corresponding Author InformationCorresponding author. Tel.: +44 116 258 7506; fax: +44 116 258 6089.
    • ,
  • John Thompson

      Affiliations

    • Department of Epidemiology, Leicester and Warwick Medical School, University of Leicester, Leicester, UK
    • ,
  • John Stevenson

      Affiliations

    • Imperial College, London, UK

Received 9 February 2005; received in revised form 21 September 2005; accepted 7 October 2005.

Abstract 

Objectives

To evaluate the impact of metabolic effects of different progestogens on the risk of fatal myocardial infarction is evaluated.

Methods

The changes in (apo)lipoproteins obtained from a randomized trial of three hormone therapy regimens were applied to three models for predicting fatal myocardial infarction derived from the apolipoprotein-related mortality risk (AMORIS) study. In our trial, 487 postmenopausal women were randomized to oral estradiol, with sequential addition of two trimegestone (TMG) doses or norethisterone acetate (NETA), and studied at baseline and after 3, 6, and 12 months.

Results

The change from baseline in risk of fatal myocardial infarction, using AMORIS model 3, containing total cholesterol, triglycerides, and apolipoprotein AI, was a 10% reduction for the two TMG doses; NETA had no apparent impact. The differences between treatments were significant at all three time points. When apoB was added in AMORIS model 4, the difference between treatments (5% reduction in the two doses of TMG, compared to NETA) decreased over time, probably due to the effect of dropouts in the NETA group.

Conclusions

This analysis shows different metabolic responses to progestogens in terms of risk of fatal myocardial infarction. Generalization of health benefits or adverse effects seen in trials of hormone therapy to other progestogens could be misleading.

Keywords: Apolipoprotein B, Apolipoprotein AI, Lipids, Menopause, Progestogens, Estrogen, Trimegestone, AMORIS

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PII: S0378-5122(05)00263-X

doi:10.1016/j.maturitas.2005.10.004

Maturitas
Volume 54, Issue 2 , Pages 154-163, 20 May 2006

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