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Shin, Cha, Chung, Shim, and Lee: The Effect of Hormone Replacement Therapy on Carotid Intima-Media Thickness in Healthy Postmenopausal Women
Original Article
Journal of Korean Society of Endocrinology

Journal of Korean Society of Endocrinology 2006; 21(1): 14-21.

Published online: 20 February 2006

DOI: https://doi.org/10.3803/jkes.2006.21.1.14

The Effect of Hormone Replacement Therapy on Carotid Intima-Media Thickness in Healthy Postmenopausal Women

Jang Yel Shin, Bong Soo Cha1, Choon Hee Chung, Won-Heum Shim1, Hyun Chul Lee1

Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Received 22 August 2005       Accepted 24 November 2005

Copyright © 2006 Korean Endocrine Society

Abstract

Background

Cardiovascular disease is the leading cause of death in postmenopausal women. The use of hormone replacement therapy (HRT) preventing for cardiovascular disease in postmenopausal women remains controversial. We investigated the effect of HRT on carotid intima-media thickness (IMT) according to the HRT duration in healthy postmenopausal women.

Methods

One hundred and twenty postmenopausal women (mean age: 55.4 ± 3.3 years) were classified into never users, short-term, and long-term users according to the HRT duration. Carotid IMT was measured, and the clinical and biochemical cardiovascular risk factors were examined.

Results

The mean IMT was significantly thinner in the long-term users than that in the never users (0.62 ± 0.11 vs. 0.71 ± 0.14 mm, P < 0.01). Also, the maximal IMT was significantly thinner in the short-term and the long-term users. However, there is no significant difference in the mean and maximal IMTs between the estrogen alone and estrogen plus progestins used group. The period exposed to menopause was significantly shorter in the long-term users than that in the never users (1.8 ± 2.3 vs. 4.3 ± 3.3 years, P < 0.001).

Conclusion

Our findings suggest that if HRT is initiated during early postmenopausal period before the onset of atherosclerosis, HRT may have a beneficial effect on the prevention of carotid atherosclerosis.

Keywords: Atherosclerosis, Cardiovascular disease, Hormone replacement therapy, Intima media thickness, Postmenopause

Figures and Tables

Table 1
Clinical and Biochemical Characteristics of the Postmenopausal Women according to the HRT Duration
jkse-21-14-i001

Values are the means ± SD (standard deviation) and percent (%). CVD, cardiovascular disease; Total C, total cholesterol; TG, triglyceride; N/S, not significant.

Table 2
IMT of the Carotid Artery in the Postmenopausal Women according to the HRT Duration
jkse-21-14-i002

Values are the means ± SD.

*, P < 0.05 vs. never users; †, P < 0.01 vs. never users.

Table 3
Clinical Characteristics in the Postmenopausal Women according to the Presence of Estrogen and Estrogen in Combination with Progestins
jkse-21-14-i003

Values are means ± SD. N/S, not significant.

*, estrogen (CEE 0.625 mg/day) monotherapy; †, combination therapy with progesterone (MPA 2.5 mg/day).

References

1. Johansson S, Vedin A, Wilhelmsson C. Myocardial infarction in women. Epidemiol Rev. 1983. 5:67–95.
2. American Heart Association. Heart disease and stroke statistics-2000 update. 1999. Dallas: Tex American Heart Association;1–32.
3. Kannel WB, Hjortland MC, McNamara PM, Gordon T. Menopause and risk of cardiovascular disease: the Framingham study. Ann Intern Med. 1976. 85:447–452.
4. Colditz GA, Willet WC, Stampfer JJ, Rosner B, Speizer FE, Hennekens CH. Menopause and the risk of coronary heart disease in women. N Engl J Med. 1987. 316:1105–1110.
5. Stampfer MJ, Colditz GA, Willet WC. Menopause and heart disease: a review. Ann N Y Acad Sci. 1990. 592:193–203.
6. Stampfer MJ, Colditz GA, Willet WC, Manson JE, Rosner B, Speizer FE, Hennekens CH. Postmenopausal estrogen therapy and cardiovascular disease. Ten-year follow-up from the Nurses' Health Study. N Engl J Med. 1991. 325:756–762.
7. Barrett-Connor E, Bush TL. Estrogen and coronary heart disease in women. JAMA. 1991. 265:1861–1867.
8. Sullivan JM, Vander Zwaag R, Lemp GF, Hughes JP, Maddock V, Kroetz FW, Ramanathan KB, Mirvis DM. Postmenopausal estrogen use and coronary atherosclerosis. Ann Intern Med. 1988. 108:358–363.
9. Bush TL, Barrett-Connor E, Cowan LD, Criqui MH, Wallace RB, Suchindran CM, Tyroler HA, Rifkind BM. Cardiovascular mortality and non-contraceptive use of estrogen in women: results from the Lipid Research Clinics Program Follow-up Study. Circulation. 1987. 75:1102–1109.
10. The Writing Group for the PEPI Trial. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: The Postmenopausal Estrogen/Progestin Interventions (PEPI) trial. JAMA. 1995. 273:199–208.
11. Manson JE, Martin KA. Clinical practice: Postmenopausal hormone replacement therapy. N Engl J Med. 2001. 345:34–40.
12. Koh KK, Ann JY, Kang MH, Kim DS, Jin DK, Sohn MS, Park GS, Choi IS, Shin EK. Effects of hormone replacement therapy on plaque stability, inflammation, and fibrinolysis in hypertensive or overweight postmenopausal women. Am J Cardiol. 2001. 88:1423–1426.
13. Cushman M, Legault C, Barrett-Connor E, Stefanick ML, Kessler C, Judd HL, Sakkinen PA, Tracy RP. Effect of postmenopausal hormones on inflammationsensitive proteins: The Postmenopausal Estrogen/ Progestin Interventions (PEPI) Study. Circulation. 1999. 100:717–722.
14. Koh SCL, Dramusic V, Ratnam SS. The effects of long-term hormone replacement therapy on coagulation, fibrinolysis and inhibitors in postmenopausal women. Intern J Gynaecol Obstet. 1998. 62:279–285.
15. Koh KK, Horne MK, Csako G, Waclawiw MA, Cannon RO. Relation of fibrinolytic potentiation by estrogen to coagulation pathway activation in postmenopausal women. Am J Cardiol. 1999. 83:466–469.
16. Mendelsohn ME, Karas RH. Mechanisms of disease: The protective effects of estrogen on the cardiovascular system. N Engl J Med. 1999. 340:1801–1811.
17. Mendelsohn ME, Karas RH. Estrogen and the blood vessel wall. Curr Opin Cardiol. 1994. 9:619–626.
18. Li G, Chen YF, Greene GL, Oparil S, Thompson JA. Estrogen inhibits vascular smooth muscle celldependent adventitial fibroblast migration in vitro. Circulation. 1999. 100:1639–1645.
19. Hulley S, Grady D, Bush T, Furberg C, Herrington D, Vittinghoff E. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA. 1998. 280:605–613.
20. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J. Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA. 2002. 288:321–333.
21. Howard G, Sharrett AR, Heiss G, Evans GW, Chambless LE, Riley WA, Burke GL. Carotid artery intimal-medial thickness distribution in general populations as evaluated by B-mode ultrasound. ARIC Investigators. Stroke. 1993. 9:1297–1304.
22. Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intima-media thickness and risk of stroke and myocardial infarction. the Rotterdam Study. Circulation. 1997. 96:1432–1437.
23. Burke GL, Evans GW, Riley WA, Sharrett AR, Barnes RW, Crow RS, Rautaharju PM, Heiss G. Arterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults: the ARIC study. Stroke. 1995. 26:386–391.
24. Hodis HN, Mack WJ, LaBree L, Selzer RH, Liu CR, Liu CH, Azen SP. The role of carotid arterial intima-media thickness in predicting clinical coronary events. Ann Intern Med. 1998. 128:262–269.
25. Sutton-Tyrrell K, Lassila HC, Meilahn E, Bunker C, Mattews KA, Kuller LH. Carotid atherosclerosis in premenopausal and postmenopausal women and its association with risk factors measured after menopause. Stroke. 1998. 29:1116–1121.
26. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972. 18:499–502.
27. Women's Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. The Women's Health Initiative randomized controlled trial. JAMA. 2004. 291:1701–1712.
28. Herrington DM, Reboussin DM, Brosnihan KB, Sharp PC, Shumaker SA, Snyder TE, Furberg CD, Kowalchuk GJ, Stuckey TD, Rogers WJ, Givens DH, Waters D. Effects of estrogen replacement on the progression of coronary artery atherosclerosis. N Engl J Med. 2000. 343:522–529.
29. Hodis HN, Mack WJ, Lobo RA, Shoupe D, Sevanian A, Mahrer PR, Selzer RH, Liu CR, Liu CH, Azen SP. Estrogen in the prevention of atherosclerosis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2001. 135:939–953.
30. Eaker ED, Chesebro JH, Sacks FM, Wenger NK, Whisnant JP, Winston M. Cardiovascular disease in women. Circulation. 1993. 88:1999–2009.
31. Grodstein F, Stampfer MJ, Manson JE, Colditz GA, Willett WC, Rosner B, Speizer FE, Hennekens CH. Postmenopausal estrogen and progestin use and the risk of cardiovascular disease. N Engl J Med. 1996. 335:453–461.
32. Godsland IF. Effects of postmenopausal hormone replacement therapy on lipid, lipoprotein, and apolipoprotein (a) concentrations: analysis of studies published from 1974-2000. Fertil Steril. 2001. 75:898–915.
33. Liang YL, Teede H, Shiel LM, Thomas A, Craven R, Sachithanandan N, McNeil JJ, Cameron JD, Dart A, McGrath BP. Effects of oestrogen and progesterone on age-related changes in arteries of postmenopausal women. Clin Exp Pharmacol Physiol. 1997. 24:457–459.
34. Jonas HA, Kronmal RA, Psaty BM, Manolio TA, Meilahn EN, Tell GS, Tracy RP, Robbins JA, Anton-Culver H. Current estrogen-progestin and estrogen replacement therapy in elderly women: association with carotid atherosclerosis. CHS Collaborative Research Group. Cardiovascular Health Study. Ann Epidemiol. 1996. 6:314–323.
35. Byington RP, Furberg C, Herrington DM, Herd JA, Hunninghake D, Lowery M, Riley W, Craven T, Chaput L, Ireland CC, Applegate WB. Heart and Estrogen/Progestin Replacement Study Research Group. Effect of estrogen plus progestin on progression of carotid atherosclerosis in postmenopausal women with heart disease: HERS B-mode substudy. Arterioscler Thromb Vasc Biol. 2002. 22:1692–1697.
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