Issue 215 Item 6 Hormone Therapy Hastens Plaque Formation in Diabetic Women

When treated with postmenopausal hormone therapy (HRT), women with abnormal glucose tolerance (AGT) experience greater atherosclerotic progression than healthy women.

"This study provides evidence that hormone therapy should not be used to reduce cardiovascular disease risk in women with diabetes or pre-diabetes," lead author Dr. Barbara Howard, from MedStar Research Institute in Hyattsville, Maryland, said in a statement.

The current report is the most recent to cast doubt on the safety and benefits of hormone replacement therapy. The most damning evidence to date came in 2002 when the Women’s Health Initiative (WHI) trial was stopped early after such therapy was linked to an increased risk of breast cancer, thromboembolic events, and stroke.

"The present study is the first to examine the effect of hormone therapy on coronary atherosclerosis in

AGT women," the researchers point out.

In the study, Dr. Howard’s team evaluated the effect of treatment with estrogen, estrogen plus progestin, or placebo in 423 women who participated in the Women’s Angiographic Vitamin and Estrogen trial. Of the 321 women with exit angiograms, 140 had AGT and 181 did not. The average treatment period was 2.8 years.

The researchers’ findings are published in the June 29th rapid access issue of Circulation: Journal of the American Heart Association.

In both groups of women, hormone therapy was tied to a drop in LDL cholesterol levels and a rise in HDL cholesterol levels. However, AGT women were more likely to experience adverse changes in C-reactive protein and fibrinogen levels.
Hormone therapy did not seem to affect glucose metabolism in women without AGT. In women with AGT, a slight lowering in fasting glucose levels, insulin concentration, and insulin resistance was observed.

As noted, the atherosclerotic progression seen with hormone therapy was greater in AGT women than in healthy controls. In particular, the effect of such therapy on previously non-diseased segments was more pronounced in AGT women.

HRT "is associated with a worsening of coronary atherosclerosis and exacerbation of the profile of inflammatory markers in women with AGT" and, therefore, should not be used in diabetic women, the authors conclude. Circulation 2004.

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DID YOU KNOW: Within 2 years, 8 of 34 children with metabolic syndrome developed type 2 diabetes, according to the study in the June 3, 2004, issue of the New England Journal of Medicine.