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HRT reduces abdominal obesity, insulin resistance, new-onset diabetes, lipids, blood pressure, adhesion molecules and procoagulant factors in women without diabetes and reduced insulin resistance and fasting glucose in women with diabetes. Oral agents adversely affected CRP and protein S, while transdermal agents had no effects.

There is no evidence from prospective comparative trials or from observational cohort studies that metformin is associated with an increased risk of lactic acidosis, or with increased levels of lactate, compared to other anti-hyperglycemic treatments.

OBJECTIVE:To assess the effect of hormone therapy (HT) on coronary heart disease (CHD) events in younger and older postmenopausal women. DESIGN:A comprehensive database search identified randomizedcontrolled trials of HT of at least 6 months' duration that reported CHD events, defined as myocardial infarction or cardiac death. MEASUREMENTS:The pooled odds ratios (ORs) for CHD events were reported separately for younger and older women, defined as participants with mean time from menopause of less than or greater than 10 years, or mean age less than or greater than 60 years. MAIN RESULTS:Pooled data from 23 trials, with 39,049 participants followed for 191,340 patient-years, showed that HT significantly reduced CHD events in younger women (OR 0.68 T here is continuing debate about the effect of hormone therapy (HT) on coronary heart disease (CHD) outcomes. Observational studies show that women who initiate HT shortly after menopause have 40% lower risk for CHD events than nonusers.1 In contrast, the Women's Health Initiative (WHI) found that older women who started treatment many years after menopause had an increased risk of CHD events when treated with estrogen-progestin, but not with estrogen alone. 2,3 It is possible that HT has different effects in younger and older postmenopausal women. A meta-analysis of randomized trials showed that HT reduced total mortality by 40% in younger women, with a nonsignificant trend toward reduced cardiovascular deaths. 4 The WHI trials have now provided data for CHD events separately for younger and older women.With the release of the WHI data, we are now able to evaluate the effect of HT on CHD outcomes in younger and older postmenopausal women. METHODSThe MEDLINE, EMBASE, CINAHL and Cochrane databases were searched to identify relevant trials published between 1966 and November 2004. The search was augmented by scanning selected journals and references. We included randomized-controlled trials of at least 6 months duration that compared HT with placebo or no hormone therapy in postmenopausal women, and reported at least 1 CHD event. Attempts were made to obtain more information from investigators about cardiac events in the trials. Evaluation of those trials excluded for short duration revealed no CHD events. The outcome measured was CHD events, defined as myocardial infarction or death thought to be due to cardiac causes. The methodological quality of each trial was assessed and used in a sensitivity analysis. 4 The results for each trial were pooled to obtain a summary odds ratio (OR). 4,5 The analysis was performed using Meta View 4.2 (Cochrane Library Software, Oxford). Only trials that reported at least 1 event could be used in the estimate of ORs. 6Trials were divided into those with younger or older women according to the mean time from menopause at baseline, with a cutoff set at 10 years. If that information was not available, trials were divided into those with mean age of participants less than or greater than 60 years. The results were reported separately fo...

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