NO ASSOCIATION OF MENOPAUSE AND HORMONE REPLACEMENT THERAPY WITH CAROTID-ARTERY INTIMA-MEDIA THICKNESS

Background Cardiovascular disease is the major cause of death in older women. Information on the relation of menopause and hormone replaceme nt therapy with carotid atherosclerosis is limited. Methods and Result s We examined cross-sectionally the association of menopausal status, years since last menstruation, and hormone replacement therapy status with carotid artery intima-media thickness as determined by B-mode ult rasound. Female participants (n=5436) in the Atherosclerosis Risk in C ommunities Study without a history of symptomatic cardiovascular disea se were included in the analyses. Menopause status in 45- to 54-year-o ld women who had never used hormone replacement therapy was not strong ly associated with carotid intima-media thickness (mean=0.65 mm and 0. 67 mm in premenopausal and postmenopausal women, respectively, adjuste d for age, race, cigarette years of smoking, body mass index, sport in dex, systolic blood pressure, use of blood pressure medications, drink ing status, diabetes, and education level). In postmenopausal women ag ed 55 to 64 years, women with less than or equal to 5 years since last menstruation had an adjusted average intima-media thickness (0.74 mm) comparable to those with >5 years since last menstruation (0.75 mm) ( P>.05). Although hormone replacement therapy use was associated with a more favorable lipid and hemostasis profile than nonuse, its use was not associated with intima-media thickness in postmenopausal women age d 55 to 64 years (adjusted average=0.74 mm for current users of estrog en alone and approximate to 0.75 mm each for current users of estrogen plus progestin, former users, and never users). Conclusions The data suggest that the well-known associations of hormone replacement therap y with reductions in atherosclerotic cardiovascular disease may be att ributable more to acute physiological effects, such as hemodynamic cha nges or reduced thrombosis, than to atherosclerosis itself.