Effects of estrogen/medrogestone therapy on the apoprotein B-containing lipoproteins in postmenopausal women with type 2 diabetes mellitus under satisfactory and non-satisfactory glycemic control

Background: Information is lacking on the effects of hormone replacement th erapy in women with diabetes, especially during moderate chronic hyperglyce mia. Objectives: To study the effects of HRT on the lipid profile and the low de nsity lipoprotein subclass distribution in women with type 2 diabetes under satisfactory and non-satisfactory glycemic control. Methods: Fifty-four postmenopausal women after a 6 week run-in diet were ra ndomized to receive either placebo : (HbA1c <8%, n=13; HbA1c >8%, n=17) or HRT (HbA1c <8% n=11; HbA1c >8%, n=13) for 12 weeks. HRT consisted of cyclic al conjugated estrogens 0.625 mg/day plus medrogestone 5 mg/day, At the beg inning and at the end of each treatment period the LDL subclass distributio n was estimated by density gradient ultracentrifugation. Results: At the baseline and during the study. the HbA1c level was signific antly higher in hyperglycemic patients than in the near-normoglycemic contr ols (baseline 10.2+/-2.9 vs. 6.5 +/- 0.7%, P<0.01), They showed a trend for higher total and LDL cholesterol, triglycerides and lower high density lip oprotein-cholesterol compared to near-normoglycemic controls as well as sig nificantly higher triglyceride concentrations in very low density lipoprote in, intermediate density lipoprotein and LDL-1 particles and cholesterol co ntent in LDL-1 and -2 particles. HRT decreased LDL-cholesterol in both grou ps. In the normoglycemic patients a small increase in HbA1c was observed (6 .5+/-0.7 vs. 7.4+/-1%, P=0.04). In all cases, HRT not modify the proportion of LDL represented by denser LDLs. Conclusions: HRT did not modify the LDL subclass distribution, even in the presence of moderate chronic hyperglycemia in women with type 2 diabetes.