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The Effect of Hormone Replacement Therapy on Cardiovascular Risk Factors in Type 2 Diabetes
A Randomized Controlled Trial
Patrick J. Manning, MBChB, MMedSc, FRACP;
Anne Allum, EN;
Shirley Jones, RN;
Wayne H. F. Sutherland, PhD;
Sheila M. Williams, BSc(Hons)
Arch Intern Med. 2001;161:1772-1776.
Background Postmenopausal women with diabetes are at high risk for cardiovascular
disease, compared with their nondiabetic counterparts. Combined continuous
hormone replacement therapy (HRT) is associated with improvements in serum
lipoprotein levels in nondiabetic women; however, the effect in women with
diabetes has not been determined. We evaluated the effect of combined continuous
HRT on lipoprotein and coagulation factor concentrations and glycemic control
in postmenopausal women with type 2 diabetes mellitus.
Methods In a randomized controlled crossover study, 61 subjects received combined
continuous HRT or placebo. Each treatment phase was of 6 months' duration,
with an 8-week washout phase between treatment phases.
Results Total cholesterol concentration decreased by 7% (95% confidence interval
[CI], 4%-11%) during HRT. For low-density lipoprotein concentration, the mean
decrease with HRT was 12% (95% CI, 6%-17%). Apolipoprotein B levels decreased
in keeping with the reduction in low-density lipoprotein cholesterol concentrations.
There were no significant changes in concentrations of high-density lipoprotein,
its subfractions, or triglycerides. Lipoprotein(a) and fibrinogen concentrations
were reduced by 21% (95% CI, 10%-31%) and 8% (95% CI, 2%-13%), respectively,
with HRT. Fructosamine concentrations declined by 5% (95% CI, 2%-9%) during
HRT.
Conclusions In postmenopausal women with type 2 diabetes mellitus, combined continuous
HRT has beneficial effects on lipoprotein concentrations and improves some
markers of coagulation and glycemic control.
From the Departments of Medicine (Drs Manning and Sutherland and Mss
Allum and Jones) and Preventive and Social Medicine (Ms Williams), School
of Medicine, University of Otago, Dunedin, New Zealand.
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