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January 6, 2003

HRT Reduces Diabetes Rates in Some Women

Hormone replacement therapy (HRT) can reduce diabetes by 35 percent in
women with coronary disease, according to a study of more than 2000
women. The authors do not recommend the use of hormones for disease
prevention, but instead encourage further study of the effects of
estrogen and progestin hormone therapy on metabolic complications.

Principal Investigator Alka Kanaya, MD, led a team in further
analysis of data from the Heart and Estrogen/Progestin Replacement
Study (HERS). HERS was a randomized, blinded trial led by UCSF to
determine the effects of HRT compared with placebo in older
postmenopausal women with heart disease.

"The potential benefit to patients for one health outcome needs to be
weighed against the risk for others, such as coronary events and
breast cancer," said Kanaya, a UCSF assistant professor of medicine.
"But our data allude to important metabolic benefits of HRT that
should be studied further," she said. Current clinical practice
guidelines recommend the use of HRT for the short-term relief of
menopausal symptoms only.

The new study, "Glycemic Effects of Postmenopausal Hormone Therapy,"
is published in the January 6 issue of the Annals of Internal
Medicine and was funded in part by the Department of Health and Human

Some of the HERS participants had existing diabetes and some began
the trial with impaired fasting glucose (IFG), a condition in which
the blood glucose level is elevated when measured after an overnight
fast but is not high enough to be classified as diabetes. Equal
proportions of women with diabetes, with IFG, and without diabetes
were randomly assigned to HRT or placebo in the trial.

The diabetes researchers evaluated the effect of HRT on fasting
glucose levels and on any new diagnoses of diabetes among the HERS
participants over four years of follow up. All HERS participants had
their fasting glucose levels measured during a baseline exam at the
study's beginning, after the first year of the study, and at the
study's end. Researchers found that a new diagnosis of diabetes was
made during the four-year trial in a total of 160 women:  62 women
assigned to hormone therapy and 98 on placebo.

The women who received placebo had an increased risk for diabetes
which could not be explained by other factors such as weight and waist
circumference. The placebo group -- both those with and those without
diabetes at the study's beginning -- had significant worsening of
their fasting glucose measures compared with the women who received
HRT. The trend was similar among women with IFG.

HERS was the first randomized, blinded, placebo-controlled trial
large enough to detect the effects of hormone therapy on disease
outcomes. Research was conducted at outpatient and community
settings at 20 United States clinical centers. A total of 2,763
postmenopausal women with coronary heart disease were enrolled in

Guidelines for the use of HRT underwent dramatic shifts during 2002,
when further data from HERS and another trial, the Women's Health
Initiative, demonstrated elevated risks of heart disease and breast
cancer among women using post menopausal HRT.

Co-investigators of the new study are David Herrington, MD, Wake
Forest University; Eric Vittinghoff, PhD, UCSF; Feng Lin, MS, UCSF;
Deborah Grady, MD, MPH, UCSF; Vera Bittner, MD, MSPH, University of
Alabama;  Jane A. Cauley, DrPH, University of Pittsburgh; and Elizabeth
Barrett-Connor, MD, University of California, San Diego.

HERS was funded by Wyeth-Ayerst.

UCSF News:  Eve Harris


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