Meta‐analysis: effect of hormone‐replacement therapy on components of the metabolic syndrome in postmenopausal women

Salpeter, Shelley R.; Walsh, Judith M. E.; Ormiston, Thomas M.; Greyber, Elizabeth; Buckley, Nicholas S.; Salpeter, E. E.

doi:10.1111/j.1463-1326.2005.00545.x

Cited by 508 publications

(353 citation statements)

References 155 publications

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“…Confirming our results of a difference between the oral and cutaneous route of oestrogen administration on the risk of new-onset diabetes, a recent meta-analysis found a larger protective effect on components of metabolic syndrome with oral MHT than with transdermal MHT [15], possibly because of a stronger effect of oral than transdermal oestradiol on peripheral vascular reactivity [34]. Few studies have examined associations with a given progestagen according to the route of administration of the associated oestrogen.…”

Section: Discussionsupporting

confidence: 76%

“…A decreased peripheral blood flow may limit insulin delivery and promote insulin resistance. Results of the WHI trial suggested that a decrease in insulin resistance, induced by the MHT, may have been responsible for the lower incidence of diabetes observed in the women who received the active treatment [13,14]; these results were confirmed in a meta-analysis [15]. As in a recent study [36], the relationship was no longer significant after discontinuation of MHT use, when the model was adjusted for BMI during follow-up.…”

Section: Discussionmentioning

confidence: 73%

“…In the meta-analysis, MHT use was found to be associated with an increase in lean body mass and a decrease in abdominal fat [15], which could partially explain a reduced risk of diabetes in MHT users. Unfortunately, we were not able to assess potential MHT-induced changes in abdominal fat or lean mass as waist circumference was measured only once during the follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…As being overweight is a major risk factor for diabetes [27] and MHT use is associated with a lower increase in fat mass [15,[28][29][30][31], BMI may be an intermediate factor in the relationship between MHT exposure and diabetes risk. We therefore decided to present two different models.…”

Section: Methodsmentioning

confidence: 99%

“…There was also a significant fall in insulin resistance during the first year of follow-up in women treated with combined MHT or oestrogens alone [13,14]. Similarly, a recent meta-analysis examining components of the metabolic syndrome, which included 107 randomised controlled trials of at least 8 weeks' duration, showed that MHT reduced the risk of new-onset diabetes [15]. The results of observational studies are inconsistent [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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Menopausal hormone therapy and new-onset diabetes in the French Etude Epidemiologique de Femmes de la Mutuelle Générale de l’Education Nationale (E3N) cohort

et al. 2009

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Aims/hypothesis Two US randomised trials found a lower incidence of type 2 diabetes in women treated by menopausal hormone therapy (MHT) with oral conjugated equine oestrogen combined with medroxyprogesterone acetate. The purpose of this study was to evaluate the influence of various MHTs, according to their formulation and route of administration, on new-onset diabetes in a cohort of postmenopausal French women. Methods The association between MHT use and new-onset diabetes was investigated by Cox regression analysis in 63,624 postmenopausal women in the prospective French cohort of the Etude Epidemiologique de Femmes de la Mutuelle Générale de l'Education Nationale (E3N). Cases of diabetes were identified through self-reporting or drugreimbursement record linkage, and further validated. Results 1,220 new-onset diabetes cases were validated. We observed a lower risk of new-onset diabetes among women who had ever used MHT (HR 0.82 [95% CI 0.72-0.93]), compared with those who had never used MHT. Adjustment for BMI during follow-up (rather than according to baseline BMI) did not substantially modify this association.An oral route of oestrogen administration was associated with a greater decrease in diabetes risk than a cutaneous route (HR 0.68 [95% CI 0.55-0.85] vs 0.87 [95% CI 0.75-1.00], p for homogeneity = 0.028). We were not able to show significant differences between the progestagens used in combined MHT. Conclusions/interpretation Use of MHT appeared to be associated with a lower risk of new-onset diabetes. This relationship was not mediated by changes in BMI. Further studies are needed to confirm the stronger effect of oral administration of oestrogen compared with cutaneous administration.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Menopausal hormone therapy and new-onset diabetes in the French Etude Epidemiologique de Femmes de la Mutuelle Générale de l’Education Nationale (E3N) cohort

et al. 2009

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Total Antioxidant Capacity of the Diet and Risk of Age-Related Cataract

et al. 2014

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he prevalence of cataract is high in the elderly and is the leading cause of blindness worldwide. 1 Surgical extraction, the only available treatment, is a major medical cost for several countries. Oxidative stress is thought to be involved in the development of age-related cataract by causing damage to lens proteins and lipids in the epithelium of the lens. 2-4 Several factors are associated with increased oxidation of the lens, such as aging, UV light, smoking, and corticosteroid use. 5,6 Furthermore, factors such as abdominal obesity 7 and hormone therapy 8 generate proinflammatory components, contributing to increased production of reactive oxygen species, 4,9,10 and have been associated with increased risk of cataract. To our knowledge, no previous study has investigated the role of all antioxidants in the diet in relation to age-related cataract. Previous randomized clinical trials and observational studies have focused only on individual antioxidants such as vitamin C, vitamin E, and different carotenoids and have reported inconsistent results. 11 A recent Cochrane review concluded that there is no evidence from randomized clinical trials that supplements of beta-carotene, vitamin C, or vitamin E prevent or slow the progression of age-related cataract. 12 However, besides beta-carotene, vitamin C, and vitamin E, a much wider range of antioxidants is in the diet. The total antioxidant capacity (TAC) concept aims to measure the capacity from all dietary antioxidants in a single es-IMPORTANCE To our knowledge, no previous epidemiologic study has investigated the association between all antioxidants in the diet and age-related cataract. The total antioxidant capacity (TAC) concept aims to measure the capacity from all antioxidants in the diet by also taking synergistic effects into account. OBJECTIVE To investigate the association between the TAC of the diet and the incidence of age-related cataract in a population-based prospective cohort of middle-aged and elderly women. DESIGN, SETTING, AND PARTICIPANTS Questionnaire-based nutrition survey within the prospective Swedish Mammography Cohort study, which included 30 607 women (aged 49-83 years) who were observed for age-related cataract incidence for a mean of 7.7 years. EXPOSURE The TAC of the diet was estimated using a database of foods analyzed with the oxygen radical absorbance capacity assay. MAIN OUTCOMES AND MEASURES Information on incident age-related cataract diagnosis and extraction was collected through linkage to registers in the study area. RESULTS There were 4309 incident cases of age-related cataracts during the mean 7.7 years of follow-up (234 371 person-years). The multivariable rate ratio in the highest quintile of the TAC of the diet compared with the lowest was 0.87 (95% CI, 0.79-0.96; P for trend = .03). The main contributors to dietary TAC in the study population were fruit and vegetables (44.3%), whole grains (17.0%), and coffee (15.1%). CONCLUSIONS AND RELEVANCE Dietary TAC was inversely associated with the risk of age-related cataract....

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Women's Health Initiative Hormone Therapy Trials

Bassuk

Manson

2005

Encyclopedia of Statistical Sciences

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The Women's Health Initiative (WHI) postmenopausal hormone therapy (HT) trials were designed to determine the balance of benefits and risks of HT taken for chronic disease prevention by initially healthy postmenopausal women (age range, 50—79 years; mean age, 63 years). Women with an intact uterus were randomized to estrogen–progestin or placebo for a mean of 5.6 years; women with hysterectomy were randomized to estrogen alone or placebo for a mean of 7.1 years. Compared with their respective placebo‐group counterparts, women in the estrogen–progestin group were significantly more likely to experience an adverse health event, whereas women in the estrogen‐alone group were as likely to do so. Specifically, estrogen–progestin was associated with increased risks of coronary heart disease (CHD), stroke, venous thromboembolism, and breast cancer, as well as reduced risks of hip fracture and colorectal cancer. Estrogen alone was associated with an increased risk of stroke and a reduced risk of hip fracture; it had no effect on CHD risk. The results do not support the use of HT for chronic disease prevention in postmenopausal women as a whole. However, because few WHI participants were within 5 years of menopause, these trials cannot conclusively determine the risk–benefit balance of HT in recently menopausal women. Accumulating data suggest that the timing of HT initiation in relation to age or menopause onset may critically influence the relationship between such therapy and risk of CHD as well as its overall risk–benefit balance, with younger or recently menopausal women experiencing more favorable effects than older women or women further from menopause.

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Meta‐analysis: effect of hormone‐replacement therapy on components of the metabolic syndrome in postmenopausal women

Cited by 508 publications

References 155 publications

Menopausal hormone therapy and new-onset diabetes in the French Etude Epidemiologique de Femmes de la Mutuelle Générale de l’Education Nationale (E3N) cohort

Menopausal hormone therapy and new-onset diabetes in the French Etude Epidemiologique de Femmes de la Mutuelle Générale de l’Education Nationale (E3N) cohort

Total Antioxidant Capacity of the Diet and Risk of Age-Related Cataract

Women's Health Initiative Hormone Therapy Trials

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