CURRENT ESTROGEN-PROGESTIN AND ESTROGEN REPLACEMENT THERAPY IN ELDERLY WOMEN - ASSOCIATION WITH CAROTID ATHEROSCLEROSIS

The cardioprotective effects of combined estrogen/progestin replacemen t therapy have been questioned. Therefore, we have compared carotid ar terial wall thickening and the prevalence of carotid stenosis in elder ly women (greater than or equal to 65 years old) currently using repla cement estrogen/progestins (E+P) with arterial pathology and its preva lence in women using unopposed estrogens (E). This cross-sectional stu dy used baseline data from all 2962 women participating in the Cardiov ascular Health Study, a population-based study of coronary heart disea se and stroke in elderly adults. Users of hormone replacement therapy (HRT) were categorized as never (n = 1726), past (n = 787), current E (n = 280), or current E+P (n = 73). Maximal intimal-medial thicknesses of the internal and common carotid arteries and stenosis of the inter nal carotid arteries were measured by ultrasonography. Current E+P use rs resembled current E users in most respects, although some lifestyle factors were more favorable among E+P users. Current ESP use and curr ent E use (as compared with no use) were associated with smaller inter nal carotid wall thicknesses (-0.22 mm; P = 0.003; and -0.09 mm; P = 0 .05, respectively) and smaller common carotid wall thicknesses (-0.05 mm; P = 0.03; and -0.02 mm; P = 0.1, respectively) and lower odds rati os (OR) for carotid stenosis (greater than or equal to 1% vs. 0%); OR = 0.61; 95% confidence interval [CI]: 0.36 to 1.01; and OR = 0.91, 95% CI: 0.67 to 1.24, respectively, after adjustment for current lifestyl e and risk factors. When both groups of current HRT users were compare d, there were no significant differences in carotid wall thicknesses o r prevalence of carotid stenosis. For this sample of elderly women, bo th current E+P therapy and current E therapy were associated with decr eased measures of carotid atherosclerosis. These measures did not diff er significantly between the two groups of HRT users. Ann Epidemiol 19 96; 6:314-323.