Relation between hormone replacement therapy and ischaemic heart disease in women: prospective observational study

Løkkegaard, Ellen; Pedersen, A.T.; Heitmann, Berit Lilienthal; Jovanovic, Zlatko; Keiding, Niels; Hundrup, Yrsa Andersen; Obel, Erik B.; Ottesen, Bent

doi:10.1136/bmj.326.7386.426

Cited by 46 publications

(36 citation statements)

References 30 publications

(20 reference statements)

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“…Although this phenomenon can be seen in the current study too, the female disadvantage was seen with both absolute and relative measures, and a clearly significant interaction between sex and type 2 diabetes was found. Since the interaction is also supported by a recent Finnish study on the risk of CHD (2), other mechanisms must be working too, such as possible postmenopausal changes in sexual hormones or estrogen replacement therapy (17). Unfortunately, this was not accounted for in the present study.…”

Section: Research Design Andmentioning

confidence: 62%

Female Advantage in AMI Mortality Is Reversed in Patients With Type 2 Diabetes in the Skaraborg Project

Larsson

Gullberg²,

Merlo³

et al. 2005

Diabetes Care

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Section: Research Design Andmentioning

confidence: 62%

Female Advantage in AMI Mortality Is Reversed in Patients With Type 2 Diabetes in the Skaraborg Project

Larsson

Gullberg²,

Merlo³

et al. 2005

Diabetes Care

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“…How the balance of risks and benefits influences outcomes in women with diabetes remains uncertain. Two observational studies have reported a decrease in risk of myocardial infarction associated with current use of estrogen plus progestin among women with diabetes (6,7), whereas a third study has reported an increased risk (8). The purpose of this casecohort study was to determine the association between postmenopausal estrogen therapy and fatal and nonfatal cardiovascular disease among women with type 2 diabetes.…”

mentioning

confidence: 99%

Estrogen Therapy and Risk of Cardiovascular Events Among Women With Type 2 Diabetes

et al. 2003

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OBJECTIVE -To evaluate the association between estrogen therapy and cardiovascular disease risk among women with type 2 diabetes. RESEARCH DESIGN AND METHODS-A retrospective, case-cohort study was conducted among 6,017 women aged 45-80 years with type 2 diabetes from 1 January 1986 to 31 December 1992 at the Group Health Cooperative in Washington state. Cardiovascular outcomes, including nonfatal myocardial infarction (n ϭ 215), coronary revascularization (n ϭ 253), and cardiovascular deaths (n ϭ 229), were ascertained through 31 December 1998. Use of estrogen and progestin was derived from automated pharmacy records and modeled as a timedependent variable. Median follow-up was 6.8 years. Multivariable-adjusted relative risk (RR) and 95% CI were calculated using Cox proportional hazard models for case-cohort analyses.RESULTS -Current use of estrogen with (RR 0.43, 95% CI 0.22-0.85) or without (0.48, 0.30 -0.78) progestin was associated with a decreased risk of cardiovascular events compared with never having used estrogen. Risk of cardiovascular events associated with a first episode of estrogen use (with or without progestin) of Ͻ25 months' duration (1.12, 0.49 -2.54), first episode of use Ն25 months' duration (0.32, 0.06 -1.70), and current use that was not the first episode of use (0.42, 0.42-0.67) indicated that recent initiation was not associated with an increase or decrease in risk.CONCLUSIONS -These results show an association of estrogen therapy, with or without progestin, with decreased risk of cardiovascular events among women with type 2 diabetes. This association should be further investigated in large randomized, controlled trials.

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“…Essa estratégia de individualização terapêutica torna-se ainda mais importante quando se refere a subgrupos de pacientes com patologias específicas, como é o caso do DM. Recentemente, estudo observacional mostrou que mulheres com DM em uso de TRH têm maior risco de doença cardiovascular e morte do que mulheres com DM não usuárias de TRH (25), o que reforça a idéia de se buscar alternativas seguras para o alívio de sintomas climatéricos em mulheres com DM.…”

Section: Discussionunclassified

Terapêutica com tibolona em mulheres diabéticas na pós-menopausa: parâmetros clínicos e laboratoriais de segurança

Freitas

Prado

et al. 2005

Arq Bras Endocrinol Metab

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RESUMOObjetivo: determinar o perfil de segurança clínico-laboratorial da terapia com tibolona em mulheres portadoras de diabetes mellitus não-insulinodependente (DMNID). Método: estudo prospectivo, longitudinal, aberto e controlado envolvendo 24 mulheres na pós-menopausa portadoras de DMNID, tratadas seqüencialmente com placebo (6 meses) e tibolona 2,5mg/dia (6 meses). Parâmetros clínicos, antropométricos, bioquímicos, hormonais e ultra-sonográficos foram avaliados no período basal, após 6 (tempo 1) e 12 meses de acompanhamento (tempo 2). Análise estatística foi realizada utilizando-se ANOVA para medidas repetidas, com nível de significância 5%. Resultados: efeitos colaterais surgiram apenas durante uso da tibolona (cefaléia e mastalgia em 8,3% e sangramento genital em 16,6%). Houve diminuição significativa dos sintomas climatéricos avaliados através do índice de Blatt-Kuperman [22,2 ± 7,1 (basal) vs. 13,6 ± 6,7 (tempo 1) vs. 3,1 ± 3,3 (tempo 2); p< 0,0001]. Após uso da tibolona, evidenciamos reduções significativas no percentual de gordura corporal, pressão arterial diastólica, níveis de transaminases, triglicerídeos e HDL-colesterol. Não houve variações significativas na pressão arterial sistólica, freqüência cardíaca, índice de massa corporal, relação cintura/quadril, glicemia de jejum, hemoglobina glicosilada, uréia, colesterol total e LDL-colesterol. A avaliação ultra-sonográfica não revelou variações significativas do volume uterino e espessura endometrial. Conclusão: o tratamento com tibolona em curto prazo mostrou bom perfil de segurança clínico-laboratorial em pacientes na pós-menopausa portadoras de DMNID. (6 months) and 2.5mg/day tibolone (6 months). Clinical evaluation, anthropometric parameters, biochemical and hormonal measurements, and transvaginal ultrasonography were performed at baseline and after 6 (time 1) and 12 months of follow-up (time 2). Statistical analysis was performed by repeated measures analysis of variance, with the level of significance set at 5%. Results: Side effects were present only during tibolone use (headache and mastalgia in 8.3% and genital bleeding in 16.6%). There was a significant reduction in the climacteric symptoms evaluated by Blatt-Kupperman index [22.2 ± 7.1 (baseline) vs. 13.6 ± 6.7 (time1) vs. 3.1 ± 3.3 (time 2); p< 0.0001]. After the tibolone use, we observed significant reductions in % body fat, diastolic arterial pressure, aminotransferases, triglycerides and HDL-cholesterol. There were no significant variations in artigo original

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Relation between hormone replacement therapy and ischaemic heart disease in women: prospective observational study

Abstract: Objective To investigate the risk of ischaemic heart disease and myocardial infarction among women using hormone replacement therapy, especially the potential modifying effect of cardiovascular risk factors.

Cited by 46 publications

References 30 publications

Female Advantage in AMI Mortality Is Reversed in Patients With Type 2 Diabetes in the Skaraborg Project

Female Advantage in AMI Mortality Is Reversed in Patients With Type 2 Diabetes in the Skaraborg Project

Estrogen Therapy and Risk of Cardiovascular Events Among Women With Type 2 Diabetes

Terapêutica com tibolona em mulheres diabéticas na pós-menopausa: parâmetros clínicos e laboratoriais de segurança

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