Association of Hormone-Replacement Therapy with Various Cardiovascular Risk Factors in Postmenopausal Women
Azmi A. Nabulsi, Aaron R. Folsom, Alice White, Wolfgang Patsch, Gerardo Heiss, Kenneth K. Wu, Moyses Szklo, for The Atherosclerosis Risk in Communities Study Investigators
Background Most epidemiologic studies of cardiovascular diseasein postmenopausal women suggest that estrogen-replacement therapyhas a protective effect. The effects of the use of estrogencombined with progestin are less well studied.
Methods To examine the associations of hormone-replacement therapywith concentrations of plasma lipids and hemostatic factors,fasting serum concentrations of glucose and insulin, and bloodpressure, we studied 4958 postmenopausal women participatingin a population-based investigation. Using cross-sectional data,we classified the women into four groups according to theiruse of hormone-replacement therapy: current users of estrogenalone, current users of estrogen with progestin, nonusers whohad formerly used these hormones, and nonusers who had neverused them.
Results Current users had higher mean levels of high-densitylipoprotein cholesterol, its subfractions high-density lipoprotein2and high-density lipoprotein3, and apolipoprotein A-I than nonusers,and lower mean levels of low-density lipoprotein cholesterol,apolipoprotein B, lipoprotein(a), fibrinogen, antithrombin III,and fasting serum glucose and insulin. However, current usersof estrogen alone had higher triglyceride, factor VII, and proteinC levels than either nonusers or current users of estrogen withprogestin. After making certain assumptions, we estimated thatthe findings, if causal, would translate into a reduction of42 percent in the risk of coronary heart disease in users ofhormones as compared with nonusers. Women using estrogen withprogestin would have an even greater estimated benefit.
Conclusions A randomized trial is needed to eliminate possibleselection biases in our observational study that are relatedto the prescription of replacement hormones. Nevertheless, hormone-replacementtherapy appears to be associated with a favorable physiologicprofile, which probably mediates its protective effects on cardiovasculardisease. The use of estrogen combined with progestin appearsto be associated with a better profile than the use of estrogenalone.
Source Information
From the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (A.A.N., A.R.F.); the ESP Division, Burroughs-Wellcome Company, Research Triangle Park, N.(A.W.); the Atherosclerosis Clinical Laboratory, Methodist Hospital, Houston (W.P.); the School of Public Health, Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); the Division of Hematology-Oncology, University of Texas Medical School, Houston (K.K.W.); and the Johns Hopkins School of Hygiene and Public Health, Baltimore (M.S.).
Address reprint requests to Dr. Folsom at the Division of Epidemiology, School of Public Health, University of Minnesota, 1300 S. Second St., Suite 300, Minneapolis, MN 55454.
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(A.W.); the Atherosclerosis Clinical Laboratory, Methodist Hospital, Houston (W.P.); the School of Public Health, Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); the Division of Hematology-Oncology, University of Texas Medical School, Houston (K.K.W.); and the Johns Hopkins School of Hygiene and Public Health, Baltimore (M.S.).
