Hormone replacement therapy, cardiovascular risk and diabetes

Abstract

AbstractWomen with type 2 diabetes are at increased risk of cardiovascular disease due to several factors including hypertension, an adverse lipid profile and endothelial dysfunction. Observational studies into the effects of hormone replacement therapy (HRT) on these factors suggested that women with diabetes could have most to gain from HRT effects on these parameters and on insulin resistance. Unfortunately, long‐term randomised controlled studies including the Heart and Estrogen/progestin Replacement Study (HERS) and the Women's Health Initiative Trial (WHI) have not confirmed these observations, and in the early years of use HRT may increase the risk of myocardial infarction and cerebrovascular accident. Many of the studies have been carried out in the USA where the formulations of HRT differ from those used in Europe, and long‐term studies powered for cardiovascular outcomes are lacking with these preparations. The age at which HRT should be started could also have an impact on cardiovascular outcomes. Osteoporosis and the symptoms of the menopause remain common, and the place of HRT in treatment needs to be revised. Copyright © 2007 John Wiley & Sons.