The effects of hormone replacement therapy on plasma lipids in type II diabetes

Objectives: The effects of hormone replacement therapy on cardiovascular ri sk factors in postmenopausal women with non-insulin dependent diabetes mell itus (type II diabetes) is uncertain. Methods: The effects of estrogen repl acement therapy (ERT, conjugated equine estrogen 0.625 mg orally daily), co mbined estrogen and continuous progestogen therapy (HRT, 0.625 mg of conjug ated equine estrogens plus medroxyprogesterone acetate 5 mg daily) or place bo was compared in 20 postmenopausal type II diabetic women and 20 normal p ostmenopausal women in a double blind, randomised, crossover study. Patient s receiving insulin were excluded from the study and all lipid modifying dr ugs were ceased at least 4 weeks prior to randomisation. Other medication i ncluding oral hypoglycaemics was kept constant for the duration of the stud y. Results: Women with type IT diabetes were a similar age (58.7 +/- 1.3 ye ars) to the non-diabetic women (59.6 +/- 1.6 years) but they had a signific antly greater body mass index, a higher incidence of treated hypertension, higher fasting plasma glucose levels, higher triglycerides and lower HDL ch olesterol levels than non-diabetic women. ERT reduced total cholesterol and LDL cholesterol by a similar extent (8.9-12.3%) in normal and type II diab etic women and increased HDL cholesterol to a similar extent in both groups (11.0 and 8.9% respectively). ERT did not significantly alter fasting trig lyceride levels in either group. The addition of medroxyprogesterone acetat e 5 mg daily abolished the increase in HDL cholesterol associated with ERT in both groups but did not significantly affect any of the other lipid meas urements. ERT and HRT did not significantly alter fasting insulin levels no r alter fasting glucose levels in either non-diabetic women or women with t ype II diabetes. Conclusions: ERT and HRT have similar effects on lipids in women with type II diabetes and non-diabetic women after 1 month of therap y. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.