HORMONE REPLACEMENT THERAPY AND ATHEROSCLEROSIS

Atherosclerotic changes associated with long-term hormone replacement therapy (HRT) were evaluated in 20 postmenopausal women (mean age, 62. 8 +/- 6.1 years). The duration of hormone therapy was 10.1 +/- 3.4 (SD ) years. For 9 women the HRT was sequential estradiol valerate plus le vonorgestrel, for 6 women estradiol valerate plus medroxyprogesterone acetate and for 5 women estradiol valerate alone. Examinations consist ed of histologic and biochemical studies of the uterine artery and ult rasonographic examinations of carotid arteries, aorta and iliac arteri es. The findings were compared with those in 20 postmenopausal women o f similar age and with similar body mass indexes who had never receive d HRT. Additionally, the same examinations were performed on 10 premen opausal women (48.3 +/- 4.6 years). The uterine artery was histologica lly normal in all the premenopausal women studied. Among the postmenop ausal women without HRT, a histologically normal uterine artery was fo und in 5% and in women on HRT in 55% of cases (P < .01). In medicolega l autopsies, atherosclerosis in the uterine artery correlated signific antly with atherosclerosis in the coronary artery and aorta. The free cholesterol content of the intima media in premenopausal women was low er than in postmenopausal women without HRT. The percentage of linolei c acid in the intima was significantly lower and that of docosapentaen oic acid significantly higher in premenopausal women and in post- meno pausal women on HRT than in postmenopausal women without HRT. In the u ltrasonographic examination atherosclerosis in the carotid artery was less common in premenopausal women and in women on HRT than in postmen opausal women without HRT. In this material, histologic, biochemical a nd radiologic studies showed that HRT may be protective against athero sclerosis.