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Comparative Study
. 2017 Jan;65(1):200-206.
doi: 10.1111/jgs.14461. Epub 2016 Nov 11.

Long-Term Hormone Replacement Therapy Is Associated with Low Coronary Artery Calcium Levels in a Cohort of Older Women: The Age, Gene/Environment Susceptibility-Reykjavik Study

Adalsteinn Gudmundsson  1   2 , Thor Aspelund  2   3 , Gunnar Sigurdsson  1   2   3 , Tamara Harris  4 , Lenore J Launer  4 , Vilmundur Gudnason  2   3 , Helgi Jonsson  1   2
Affiliations
Comparative Study

Long-Term Hormone Replacement Therapy Is Associated with Low Coronary Artery Calcium Levels in a Cohort of Older Women: The Age, Gene/Environment Susceptibility-Reykjavik Study

Adalsteinn Gudmundsson et al. J Am Geriatr Soc. 2017 Jan.

Abstract

Objectives: To assess the relationship between hormone replacement therapy (HRT) and coronary artery calcium (CAC).

Design: Cross-sectional.

Setting: Established population-based cohort in Reykjavik, Iceland.

Participants: Women (mean age 76 ± 5) who had completed questionnaires on HRT use (N = 2,867).

Measurements: Coronary artery calcium assessed using computed tomography was the outcome variable and was compared between women with history of HRT and those who had never used HRT and analyzed according to age, length of use, and time after menopause that HRT was initiated.

Results: Eight hundred seventy-two (30.4%) participants had used HRT, and 312 (10.9%) were current users. After adjustment for age, other late-life variables, and a propensity score based on midlife data for HRT use as observed in late life, there were significant negative associations between CAC and history and length of HRT use. This association was evident in all age categories. When HRT had been used for longer than 15 years, median CAC level was less than 50% of that observed in never users. The lowest CAC was observed in those who started HRT within 5 years after menopause. The prevalence of coronary events was comparable in both groups.

Conclusion: A strong association was found between long-term HRT use and low CAC. The negative association between duration of HRT and CAC was evident in all age groups of older women.

Keywords: coronary artery calcium; epidemiology; hormone replacement therapy; older women.

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Conflict of interest statement

Disclosures: Elements of Financial/Personal Conflicts Adalsteinn GudmundssonThe corresponding author 6 coauthors (TA, GS, TH, LJL, VG and HJ) Yes No Yes No Yes No Yes No Employment or Affiliation x x Grants/Funds x x Honoraria x x Speaker Forum x x Consultant x x Stocks x x Royalties x x Expert Testimony x x Board Member x x Patents x x Personal Relationship x x All coauthors declare that there are no financial interest/conflicts of interest and have approved the current manuscript.

Figures

Figure 1
Figure 1
A balance diagnostic graph showing the standardized differences of midlife variables for the HRT versus the non HRT group before and after propensity score weighting based on the midlife covariates.
Figure 2
Figure 2
Coronary artery calcium (CAC) scores and the relationship between the groups of never HRT use, previous HRT use and current HRT use in different age groups. Number of participants within age group and use of HRT is shown over each bar.
Figure 3
Figure 3
The relationship between duration of HRT and coronary calcium (CAC) score expressed as Agatston scores. The CAC score was adjusted for late life variables and the inverse probability of treatment weighting for HRT use.
Figure 4
Figure 4
Coronary artery calcium (CAC) score expressed as Agatston scores and the initiation of HRT in relation to menopause (MP) compared with never HRT users. The CAC score was adjusted for late life variables and inverse probability of treatment weighting for HRT use.
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