Still Debated: HRT Helps Heart Health?

Health-Conscious Women May Be More Prone to Taking HRT

From the WebMD Archives

Sept. 26, 2002 -- Does hormone replacement therapy (HRT) improve a woman's heart health? It's a much-debated question; studies have shown conflicting results. Now, a large study shows that HRT use may indeed improve a women's cholesterol and blood sugar levels -- major risk factors for heart disease -- especially if she is diabetic.

But the study raises a chicken-or-egg question: Is it HRT that makes the difference in women's health? Or are women who take HRT simply taking better overall care of themselves?

The latest study results were "rather surprising -- diabetic women who use HRT have lower total cholesterol levels and lower fasting glucose [blood sugar] levels, major risk factors for cardiovascular disease," study author Carlos Crespo, PhD, associate professor of epidemiology at Buffalo State University of New York, tells WebMD.

His study appears in the October issue of Diabetes Care.

Crespo's study involves data taken for six years from 2,786 women across the U.S. -- all postmenopausal and between ages 40 and 74 -- who had numerous laboratory tests and a complete physical exam. In that group, diabetics were 60% less likely to be taking HRT than nondiabetics.

The diabetics who were taking HRT, however, significantly lower levels of LDL (bad) cholesterol

and higher levels of HDL (good) cholesterol -- than diabetics not taking HRT.

"We're continuing to study these same women, to see if those using HRT are more likely to have healthier behaviors," Crespo tells WebMD.

He says HRT users may be in better control of their diabetes. Also, women taking HRT may be more likely to take vitamin supplements, since they're used to "popping an HRT pill."

Diabetic women -- whether they took HRT or not -- had worse glucose levels than the other women. They also had higher overall cholesterol levels and lower HDL levels, says Crespo.

Though it's an "interesting study," Crespo's data aren't quite as sound as another study -- the Women's Health Initiative -- which reported this summer that HRT did not improve cardiovascular health of diabetic women, says Kathryn Rexrode, MD, MPH, women's health specialist at Brigham and Women's Hospital and assistant professor of medicine at Harvard Medical School.

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She points out that the WHI study was the gold standard type of study, in which some women were randomly given HRT and others were not, and their progress was tracked.

If Crespo can replicate his findings in a similar trial, "they might have something," says Rexrode. "But right now, randomized trial data does not show a difference in cardiovascular effects for diabetic and nondiabetic women."

Indeed, a lot of studies show that HRT users themselves are different from nonusers. "Because they're going to a doctor to get a prescription for HRT, they're more likely to be involved in other healthy behaviors. At the time this data was collected, HRT was considered a beneficial thing."

Crespo says that although there are some risks with certain types of HRT, diabetics still might benefit from HRT.

Rexrode also wonders if the HRT users were also taking statins (drugs that improve cholesterol levels). But Crespo doubts it. "Statins have become fashionable lately, but were not in 1988 to 1994 [the study period]. Even if they were fashionable, they might not have been recommended for diabetics."

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