Can Postmenopausal Hormone Replacement Improve Plasma Lipids in Women With Diabetes?
- Jennifer G Robinson, MD, MPH,
- Aaron R Folsom, MD, MPH,
- Azmi A Nabulsi, MD, MPH,
- Robert Watson, DVM, MPH, PHD,
- Frederick L Brancati, MD, MHS,
- Jianwen Cai, PHD and
- For the Atherosclerosis Risk in Communities Study Investigators
- Iowa Heart Center, Des Moines, Iowa
- Division of Epidemiology, School of Public Health, University of Minnesota Minneapolis, Minnesota
- Abbott Laboratories, Epidemiology and Outcomes Research Department Abbott Park, Illinois
- Division of Epidemiology, University of Mississippi Medical Center Jackson, Mississippi
- Departments of Medicine and Epidemiology, Johns Hopkins Medical Institutions, Welch Center for Prevention Epidemiology, and Clinical Research, Baltimore, Maryland
- Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill Chapel Hill, North Carolina
- Address correspondence and reprint requests to Aaron R. Folsom, MD, MPH, the Division of Epidemiology, School of Public Health, University of Minnesota, 1300 S. Second St., Suite 300, Minneapolis, Minnesota 55454
Abstract
OBJECTIVE To evaluate the association of postmenopausal hormone replacement with plasma lipids in diabetic women.
RESEARCH DESIGN AND METHODS Cross-sectional data from a multiracial population study were used to evaluate the relationship of hormone replacement status with plasma lipids in diabetic (n = 694) versus nondiabetic (n = 5,321) postmenopausal women.
RESULTS Although diabetic women who currently used hormone replacement had higher adjusted mean HDL cholesterol levels than those who did not (56.9 vs. 53.6 mg/dl), they had proportionately lower hormone-related increases in HDL, HDL2, and HDL3 cholesterol than did nondiabetic women (HDL cholesterol 64.9 [current users] vs. 55.7 mg/dl [those who never used hormones]). There was a trend toward greater triglyceride values with hormone replacement in diabetic women (156.6 [current users] vs. 125.4 mg/dl [those who never used hormones]) than in nondiabetic women (143.3 [current users] vs. 123.7 mg/dl [those who never used hormones]). LDL cholesterol and apolipoprotein B levels were lower and apolipoprotein A-I levels were higher with hormone replacement, to a similar degree in diabetic and nondiabetic women.
CONCLUSIONS Diabetic women appear to have a blunted response to the HDL-raising effects of estrogen and an exaggerated hypertriglyceridemic response. This may result in attenuated cardioprotection from postmenopausal hormone replacement therapy and potentially an increased risk of acute pancreatitis from hypertriglyceridemia. The risks and benefits of postmenopausal hormone replacement need to be carefully weighed in diabetic women.
- Received June 2, 1995.
- Revision received November 30, 1995.
- Accepted November 30, 1995.
- Copyright © 1996 by the American Diabetes Association
