The pharmacology and effectiveness of specific lipid-active drugs: estrogen/sex steroids.

Estrogen has favorable effects on lipid and lipoprotein coronary risk factors when given orally. These effects are less evident when estrogen is given in non-oral forms. The effects of progestins and androgens are generally opposed to those of estrogen, although their effects on lipoprotein (a) [Lp(a)] do not follow this general rule. Estrogen-progestin and androgens have been shown to reduce Lp(a), but Lp(a) reduction is less when conjugated estrogens and medroxyprogesterone are combined than when estrogen is used alone. Overall, the effects of estrogens (both alone and in combination with progestin) on lipid levels and other coronary risk factors, are beneficial. Whether these effects translate into beneficial effects on clinical coronary disease is a question that awaits the outcome of clinical trials in progress.