Postmenopausal Hormone Therapy Worsens Cardiovascular Disease in Women with Diabetes or Pre-Diabetes

Strategic Insights -

A new study has found that postmenopausal hormone therapy can promote cardiovascular disease in women with diabetes or pre-diabetes, despite improving their cholesterol levels, fasting glucose, and insulin resistance. The study, reported in the June 29, 2004, issue of Circulation, used angiography to document the progression of atherosclerosis in postmenopausal women with diabetes or impaired glucose tolerance who took hormones.

The researchers analyzed data from the Women's Angiographic Vitamin and Estrogen (WAVE) Study, a multicenter prospective trial that used angiography to examine women randomly assigned to postmenopausal hormone therapy (PHT) or placebo for 3 years. The study found that hormone therapy in women with abnormal glucose tolerance had adverse effects on fibrinogen and CRP levels, which are linked to cardiovascular disease.

Key Takeaways:

  • Postmenopausal hormone therapy can worsen cardiovascular disease in women with diabetes or pre-diabetes, despite improving risk factors such as cholesterol levels and fasting glucose.
  • Hormone therapy in women with abnormal glucose tolerance increased fibrinogen levels and exacerbated inflammatory markers, such as CRP, which are associated with heart disease.
  • The study found no differences in the effects of hormone therapy on diseased artery segments in women with abnormal glucose versus those with normal glucose, but found differing effects on non-diseased segments.
  • Hormone therapy was associated with a decrease in both minimum and average lumen diameter in women with diabetes or pre-diabetes, suggesting that it can make the narrowing of arteries worse.
  • The study provides further evidence that postmenopausal hormone therapy is not beneficial in preventing cardiovascular disease in diabetic women.
  • Physicians may still consider using postmenopausal hormone therapy in diabetic women who have serious menopausal side effects, but it should not be used to reduce cardiovascular disease risk.

Statistics:

  • Among the 321 women studied, 140 had diabetes or pre-diabetes and 181 had normal glucose levels.
  • Hormone therapy in women with abnormal glucose tolerance increased fibrinogen levels by an average of .022 millimeter per year (mm/y).
  • Hormone therapy in women with abnormal glucose tolerance also increased CRP levels, but decreased HDL levels.
  • The study found that lumen decreased about .022 mm/y in women with abnormal glucose tolerance, compared to .0007 mm/yr in women with normal glucose tolerance.

Sources:

  • "Postmenopausal Hormone Therapy Is Associated with an Increased Risk of Cardiovascular Disease in Women with Diabetes or Pre-Diabetes," Circulation, June 29, 2004.
  • "Hormone Replacement Therapy and Cardiovascular Disease in Postmenopausal Women," Heart Disease Weekly, July 25, 2004.
  • "The Women's Health Initiative (WHI) Hormone Trial," Journal of the American Medical Association, 2002.
  • "The Heart Estrogen Protection Study (HERS)," Journal of the American College of Cardiology, 2004.
  • "American Heart Association Guidelines for the Prevention of Heart Attack and Stroke," American Heart Association, 2004.