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Hormone replacement therapy in postmenopausal women: carotid intima-media thickness and 3-D volumetric plaque
B Griewing1, T Römer, C Spitzer
1Department of Neurology, Ernst-Moritz-Arndt University, Greifswald, Germany.
Insights
Postmenopausal hormone replacement therapy (HRT) significantly reduces carotid atherosclerosis. Women on HRT showed fewer plaques and smaller plaque volumes compared to controls, suggesting HRT
Area of Science:
- Cardiovascular Research
- Endocrinology
- Medical Imaging
Background:
- Epidemiological studies suggest a link between hormone replacement therapy (HRT) and stroke risk.
- Quantitative data on HRT's effects on carotid atherosclerosis using noninvasive ultrasound are limited.
Purpose of the Study:
- To quantitatively assess the impact of postmenopausal HRT on carotid atherosclerosis.
- To compare carotid plaque characteristics between women using HRT and a matched control group.
Main Methods:
- Examined 55 postmenopausal women on HRT (estrogen +/- progestins) and 46 controls.
- Utilized Doppler ultrasound and B-mode sonography for plaque visualization, intima-media thickness (IMT), and plaque volume quantification.
- Measurements were taken at baseline and after 1.5 years.
Main Results:
- HRT group had significantly lower carotid plaque incidence (18% vs. 61%).
- HRT subjects exhibited reduced mean intima-media thickness (IMT) in carotid arteries.
- 3-D analysis revealed smaller carotid plaque volumes in women receiving HRT.
Conclusions:
- Postmenopausal HRT is associated with reduced severity of carotid atherosclerosis.
- Hormonal effects on the carotid wall and lipoproteins may mediate these protective effects.
- HRT may be effective in managing existing atherosclerotic plaques.
Objective:
The relationship between postmenopausal hormone replacement therapy (HRT) and the risk of stroke has been investigated in a number of epidemiological studies. However, data concerning the quantitative effects of HRT on carotid atherosclerosis, as measured by noninvasive ultrasound methods, are sparse.
Methods:
In the present case, we examined 55 postmenopausal women (mean age 57.6 +/- 4.2 years) who were treated for 4.7 years with estrogens, either alone (n = 11) or in combination with progestins (n = 44). They were compared to 46 control subjects without HRT who were matched for age, hypertension, and various other vascular risk factors. At the study onset and 1.5 years later, all participants were examined by Doppler ultrasound and B-mode sonography, and plaque visualization, intima-media-thickness (IMT) and volumetric quantification of carotid plaques was performed.
Results:
The HRT group had a significantly lower incidence of carotid plaques (18%) than the control group (61%). The mean TMT for the HRT subjects was 0.52 mm in the common carotid artery and 0.46 mm in the internal carotid artery, as compared to 0.68 and 0.62 mm, respectively, for the control subjects. No significant changes in IMT were found in either group. 3-D evaluation of carotid plaques showed increased plaque volume in women without HRT compared to women with HRT.
Conclusion:
We have obtained quantitative data using different noninvasive ultrasound techniques which demonstrate that women receiving HRT develop less severe carotid atherosclerosis, an effect which may be mediated by direct hormonal effects on the carotid wall and, in part, by the indirect influence of hormones on lipoproteins. HRT may, indeed, be more effective on existing atherosclerotic plaques.