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Oral Contraceptive Use and Hormone Replacement Therapy Are Associated With Microalbuminuria
Taco B. M. Monster, MPharmSc;
Wilbert M. T. Janssen, MD, PhD;
Paul E. de Jong, MD, PhD;
Lolkje T. W. de Jong-van den Berg, MPharmSc, PhD;
for the Prevention of Renal and Vascular End Stage Disease Study Group
Arch Intern Med. 2001;161:2000-2005.
Background Controversy exists regarding the adverse and beneficial effects of oral
contraceptive use and hormone replacement therapy. Microalbuminuria is associated
with increased risk of renal and cardiovascular disease.
Objective To examine the association between oral contraceptive use or hormone
replacement therapy and microalbuminuria.
Methods We performed a case-control study of the baseline data and historical
pharmacy data of 4301 female subjects of the Prevention of Renal and Vascular
End Stage Disease study cohort, aged 28 to 75 years, excluding women who were
pregnant or had type 1 diabetes mellitus. The main outcome measure was microalbuminuria,
defined as a urinary albumin excretion of 30 to 300 mg per 24 hours (recorded
as the mean of two 24-hour urine collections).
Results After adjusting for age, hypertension, diabetes, obesity, hyperlipidemia,
and smoking, the odds ratio (OR) for having microalbuminuria was 1.90 (95%
confidence interval [CI], 1.23-2.93) for premenopausal oral contraceptive
users and 2.05 (95% CI, 1.12-3.77) for postmenopausal hormone replacement
therapy users. The point estimate increased in a dose-dependent fashion, albeit
insignificantly, according to the estrogen content of the oral contraceptives
(<30 µg ethinyl estradiol: OR, 1.11; 95% CI, 0.14-8.56; 30 to <50
µg: OR, 1.83; 95% CI, 1.17-2.87; and 50 µg: OR, 2.72; 95% CI,
0.81-9.08). The OR was greater in oral contraceptives with a second-generation
(OR, 2.04; 95% CI, 1.28-3.25) vs a third-generation progestin (OR, 1.39; 95%
CI, 0.63-3.06). The OR increased with the duration of hormone replacement
therapy ( 5 years, OR, 1.28; 95% CI, 0.37-4.50; >5 years, OR, 2.56; 95%
CI, 1.32-4.97).
Conclusion Regular and long-term oral contraceptive use and hormone replacement
therapy are associated with an increased risk for microalbuminuria and cardiovascular
disease.
From the Department of Social Pharmacy and Pharmacoepidemiology (Mr
Monster and Dr de Jong-van den Berg), and Division of Nephrology, Department
of Internal Medicine (Drs Janssen and de Jong), Groningen University Institute
for Drug Exploration, University of Groningen, Groningen, the Netherlands.
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