Review Article

Coronary Heart Disease in Postmenopausal Women with Type II Diabetes Mellitus and the Impact of Estrogen Replacement Therapy: A Narrative Review

Table 1

Summary and conclusions of some key studies focusing on the hormonal replacement therapy impact on cardiovascular risk in postmenopausal women.

StudyYearDesign of the study patientsHRTFollow-upConclusions

Grodstein et al. [9]1996Prospective study59,337ERT alone or combined HRT16 yearsCurrent hormone users, regardless of whether they used ERT alone or combined HRT, tended to have a better risk profile than women who had never used HRT.

Hulley et al. [11]
(HERS trial)
1998Randomized, blinded, placebo-controlled secondary prevention2,7630.625 mg of conjugated equine oestrogens + 2.5 mg medroxyprogesterone acetate4.1 yearsHRT did not reduce the overall rate of CAD events in PMW with established CAD. Moreover, HRT did increase the rate of thromboembolic events and gallbladder disease.

Rossouw et al. [10]
(WHI trial)
2002Randomized placebo-controlled primary prevention trial16,7080.625 mg of conjugated equine oestrogens + 2.5 mg medroxyprogesterone acetate5.2 yearsOverall health risks exceeded benefits from use of HRT in healthy PMW. HRT should not be indicated for CAD primary prevention.

Ferrara et al. [82]
(Northern California Kaiser Permanente Diabetes Registry)
2003Survey follow-up study15,435ERT alone or combined HRT3 yearsIn diabetic PMW without a recent MI, use of combined HRT was associated with decreased risk of MI. However, HRT was associated with increased risk of MI in women with history of a recent MI.

CAD: coronary artery disease; ERT: estrogen replacement therapy; HRT: hormonal replacement therapy; MI: myocardial infarction; PMW: postmenopausal women.