Hormone Replacement Therapy and Its Relationship to Lipid and Glucose Metabolism in Diabetic and Nondiabetic Postmenopausal Women

Carlos J. Crespo, DrPH, MS, Ellen Smit, PHD, RD, Anastacia Snelling, PHD, Christopher T. Sempos, PHD and Ross E. Andersen, PHD

Disclosures

Diabetes Care. 2002;25(10) 

In This Article

Abstract and Introduction

Objective: Among postmenopausal women, those with diabetes experience more cardiovascular diseases than those without diabetes. We examine the relationship of hormone replacement therapy (HRT) with indicators of lipid and glucose metabolism using a national sample of diabetic and nondiabetic postmenopausal women.
Research Design and Methods: We used data from the Third National Health and Nutrition Examination Survey, conducted from 1988 to 1994. A total of 2,786 postmenopausal women aged 40-74 years participated in an oral glucose tolerance test, had blood drawn for lipid assessment, and responded to HRT questions.
Results: Our results show that postmenopausal women with diabetes had increased dyslipidemia compared with nondiabetic women. Among diabetic women, current users of HRT had significant different lipid and glucose control levels than never users of HRT for the following variables: total cholesterol (225 vs. 241 mg/dl), non-HDL (169 vs. 188 mg/dl), apoA (171 vs. 147 mg/dl), fibrinogen (306 vs. 342 mg/dl), glucose (112 vs. 154 mg/dl), insulin (16.81 vs. 22.6 uU/ml), and GHb (6.03 vs. 7.13 mg/dl).
Conclusions: Diabetic and nondiabetic postmenopausal women currently taking HRT had better lipoprotein profile than never or previous users of HRT. Diabetic women currently taking HRT had better glycemic control than never or previous users of HRT.

Some studies have found the use of hormone replacement therapy (HRT) to be associated with a better cardiovascular health profile in healthy postmenopausal women, whereas others have found no benefits.[1,2,3,4,5,6] Epidemiological research on the potential benefits of HRT use in postmenopausal women with diabetes is also inconclusive.[7,8,9,10,11] Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Most cases of diabetes fall into two categories: type 1 and type 2 diabetes. In type 1 diabetes, the cause is an absolute deficiency of insulin secretion. In type 2 diabetes, the most common form of diabetes, the cause is a combination of resistance to insulin action and inadequate compensatory insulin secretory response. Risk factors for diabetes include age, family history, obesity, and physical inactivity. Moreover, diabetic individuals are also at higher risk for coronary heart disease, dyslipidemia, hypertension, retinopathy, and renal disorders.[7,8,10,12,13,14]

Postmenopausal women experience more type 2 diabetes and cardiovascular diseases than their premenopausal counterparts. One hypothesis concerning the increased prevalence of type 2 diabetes and cardiovascular diseases in postmenopausal women is that it may be related to age-related changes in sex-steroid hormones. Although sex hormones do not appear to play a primary role in the etiology of type 2 diabetes, they may be related to other metabolic factors. After menopause there is an increase in dyslipidemia, especially reduced levels of HDL. In addition to HDL changes, menopause is also accompanied by changes in apolipoprotein (apo)A and apoB, fibrinogen, and hyperinsulinemia.[1,2,3,5,8]

HRT may be effective in lowering the risk of cardiovascular disease in healthy menopausal women, and although postmenopausal HRT is recommended to prevent disease and prolong life, little data are available to examine the association between HRT and emerging hyperlipidemic indicators separately for diabetic subjects and nondiabetic postmenopausal women. In this study, we examined the relationship of HRT use with dyslipidemic indicators in a national sample of diabetic and nondiabetic postmenopausal women 40-74 years of age.

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