ASSOCIATION OF HORMONE REPLACEMENT THERAPY WITH HEMOSTATIC AND OTHER CARDIOVASCULAR RISK-FACTORS THE FINRISK HEMOSTASIS STUDY

The risk of cardiovascular diseases in women is small until menopause but increases considerably afterwards. When all age groups are conside red, cardiovascular diseases are responsible for approximately half of the total mortality in women. It has been suggested that hormone repl acement therapy (HRT) in perimenopausal and postmenopausal women could be useful in the prevention of cardiovascular diseases, but its effec ts are insufficiently known. We performed a cross-sectional study on t he associations of menopause and HRT with cardiovascular risk factors, in particular with hemostatic factors, on female participants of the FINRISK Hemostasis Study. The participants, aged 45 to 64 years, were recruited from the Finnish population register by random sampling from three geographically defined areas. The partic ipation rate of women was 83.2%. Of the 1202 women included in the study, 29.2% were current users of HRT. Differences in cardiovascular risk factors by menopausa l status and by HRT use were examined after adjustment for age, study area, current smoking, body mass index, self-reported diabetes, and ye ars of education. Postmenopausal women not using exogenous sex hormone s had on average a total cholesterol level 0.5 mmol/L (8.9%) higher an d an LDL cholesterol level 0.4 mmol/L (11.4%) higher than premenopausa l women. Women reporting irregular menstruation (presumably due to per imenopause) had higher adjusted plasma fibrinogen, factor VII coagulan t activity, and factor VII antigen than women with regular menstruatio n or no menstrual periods. HRT users had an adjusted total cholesterol level 0.28 mmol/L (5%) lower (P<.0001) and an adjusted LDL cholestero l level 0.3 mmol/L (7%) (P<.0001) lower than nonusers. The data also s uggested that HRT attenuated the age-dependent difference in total and LDL cholesterol (P=.01 for age by HRT interaction). HRT users had low er adjusted insulin and glucose values than nonusers. When the hemosta tic factors were studied, the users were seen to have lower adjusted f ibrinogen (P<.0001) but higher factor VII antigen (P=.007) and plasmin ogen levels (P<.0001) than nonusers. No difference was found in factor VII coagulant activity or in Lp(a). In conclusion, HRT users have cle arly more favorable lipid profiles as well as insulin and glucose valu es compared with nonusers. Accordingly, HRT can be a potentially usefu l adjunct to the prevention of cardiovascular disease. Its effects on hemostatic factors are, however, mixed and of unclear clinical signifi cance at the moment. More prospective studies on the effects of HRT on hemostasis are therefore needed before it can be recommended for the prevention of cardiovascular diseases.