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How HRT Alters the Lipid Profile in Women with Diabetes.

Although postmenopausal estrogen replacement is recommended to prevent disease and prolong life, little data are available regarding hormone replacement therapy (HRT; estrogen or estrogen plus progestin) in various high-risk subpopulations of women. Our study examined lipid levels, with and without HRT, in a cross-section of 694 postmenopausal women with diabetes and 5321 postmenopausal women without diabetes. Among the diabetic women, 70 were currently using HRT, 482 had never used HRT, and 142 had used HRT at some point after menopause but were not taking hormones at the time of the study. Among the nondiabetic women, 1147 were currently using HRT, 3210 had never used HRT, and 964 had formerly used HRT. We found that diabetic women appear to respond somewhat differently than their nondiabetic counterparts to HRT. Estrogens were associated with proportionately lower increases in HDL as compared with the increases produced in nondiabetic women--diabetic women currently taking estrogen had 6% higher HDL levels than diabetic women who never used estrogen, and nondiabetic women currently taking hormones had 17% higher HDL levels than nondiabetic subjects who were never on HRT (P=0.02). Further, there were proportional differences in triglyceride levels--diabetic women currently on HRT had 25% higher triglyceride levels than diabetic women who never used hormone therapy, and among nondiabetic women on HRT, there was a 14% increase in triglycerides compared with their counterparts who were never on HRT (P=0.08). LDL cholesterol appeared to respond similarly to HRT in diabetic and nondiabetic women. Diabetic women appear to have a blunted response to the HDL-raising effect of HRT and an exaggerated hypertriglyceridemic response. This may alter the cardiovascular benefits from postmenopausal HRT and increase the risk of acute pancreatitis from hypertriglyceridemia. The decision to use HRT should be individualized, and diabetic women who receive HRT should have their triglycerides carefully monitored at 1 month and then at every 3 months after starting therapy.