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The Rotterdam Study

Iris C. D. Westendorp, MD, PhD; Bas A. in't Veld, MD, MSc; Diederik E. Grobbee, MD, PhD; Huib A. P. Pols, MD, PhD; Wonter T. Meijer, MD, PhD; Albert Hofman, MD, PhD; Jacqueline C. M. Witteman, MD, PhD

Arch Intern Med. 2000;160:2498-2502.

Background  As the number of elderly women increases in Western society, peripheral arterial disease (PAD) is likely to become an increasing problem. Hormone replacement therapy, suggested to protect against coronary atherosclerosis, might also inhibit the development of PAD.

Methods  The association between hormone replacement therapy and the presence of PAD was studied in a population-based study consisting of 2196 naturally menopausal women aged 55 to 80 years living in a suburban area of Rotterdam, the Netherlands. Peripheral arterial disease was defined as an ankle/arm systolic blood pressure index (ratio of the systolic blood pressure at the ankle to the systolic blood pressure at the arm) lower than 0.9.

Results  Hormone replacement therapy for 1 year or longer was associated with a 52% decreased risk of PAD (odds ratio, 0.48 [95% confidence interval, 0.24-0.85]), while no association was found for therapy duration shorter than 1 year (odds ratio, 0.97 [95% confidence interval, 0.58-1.63) after adjustment for age, smoking, and socioeconomic status. Additional adjustment for body mass index, age at menopause, total cholesterol and high-density lipoprotein cholesterol, alcohol intake, and frequency of visits to health care facilities did not change the results.

Conclusion  The findings of this population-based study suggest that hormone replacement therapy given for a year or more is associated with a decreased risk of PAD among postmenopausal women.

From the Departments of Epidemiology and Biostatistics (Drs Westendorp, in't Veld, Grobbee, Pols, Meijer, Hofman, and Witteman), Internal Medicine III (Dr Pols), and General Practice (Dr Meijer), Erasmus University Medical School, Rotterdam, and the Julius Center for Patient Oriented Research, University Medical Center Utrecht, Utrecht (Dr Grobbee), the Netherlands.

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