Yilin Yoshida1, Zhipeng Chen2, Robin L Baudier3, Marie Krousel-Wood4, Amanda H Anderson3, Vivian A Fonseca5, Franck Mauvais-Jarvis6. 1. Section of Endocrinology and Metabolism, Deming Department of Medicine, Tulane University School of Medicine, United States; Tulane Center of Excellence in Sex-Based Biology & Medicine, Tulane University, United States; Southeast Louisiana VA Medical Center, New Orleans, LA, United States. Electronic address: yyoshida1@tulane.edu. 2. Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, United States. 3. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, United States. 4. Section of General Internal Medicine, Deming Department of Medicine, Tulane University School of Medicine, United States; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, United States; Tulane Center of Excellence in Sex-Based Biology & Medicine, Tulane University, United States. 5. Section of Endocrinology and Metabolism, Deming Department of Medicine, Tulane University School of Medicine, United States; Southeast Louisiana VA Medical Center, New Orleans, LA, United States. 6. Section of Endocrinology and Metabolism, Deming Department of Medicine, Tulane University School of Medicine, United States; Tulane Center of Excellence in Sex-Based Biology & Medicine, Tulane University, United States; Southeast Louisiana VA Medical Center, New Orleans, LA, United States.
Abstract
BACKGROUND AND AIMS: The effect of MHT on cardiovascular disease (CVD) risk among women with prediabetes or type 2 diabetes (PreDM or T2DM) is unclear. We examined the association between ever or early use MHT and CVD risk in postmenopausal women with PreDM or T2DM, and the potential modifying effect of race. METHODS: 2,917 postmenopausal women with PreDM or T2DM were pooled from 3 prospective CVD cohorts (the Atherosclerosis Risk in Communities, the Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study). Ever (yes vs no) or early use of MHT (MHT initiated ≤5 vs > 5 years since menopause), and their associations with ischemic stroke, coronary heart disease (CHD), and atherosclerotic cardiovascular disease (ASCVD) were assessed using Cox proportional hazards models. RESULTS: During a median follow-up of 15 years, 264 stroke, 484 CHD, and 659 ASCVD events were observed. In fully adjusted models, ever use of MHT was associated with reduced risk of stroke (hazard ratio 0.86, 95% CI 0.76-0.98), CHD (0.85, 0.74-0.98), and ASCVD (0.83, 0.73-0.95) in white women with PreDM or T2DM. Early use of MHT was associated with reduced risk of stroke (0.82, 0.72-0.95), CHD (0.85, 0.74-0.98), and ASCVD (0.82, 0.70-0.96) in the white group. No risk reduction with ever or early use of MHT was found for black women with PreDM or T2DM. CONCLUSIONS: MHT is associated with statistically reduced CVD risk among white but not black women with PreDM or DM. Race is an effect modifier in the association between MHT use and CVD.
BACKGROUND AND AIMS: The effect of MHT on cardiovascular disease (CVD) risk among women with prediabetes or type 2 diabetes (PreDM or T2DM) is unclear. We examined the association between ever or early use MHT and CVD risk in postmenopausal women with PreDM or T2DM, and the potential modifying effect of race. METHODS: 2,917 postmenopausal women with PreDM or T2DM were pooled from 3 prospective CVD cohorts (the Atherosclerosis Risk in Communities, the Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study). Ever (yes vs no) or early use of MHT (MHT initiated ≤5 vs > 5 years since menopause), and their associations with ischemic stroke, coronary heart disease (CHD), and atherosclerotic cardiovascular disease (ASCVD) were assessed using Cox proportional hazards models. RESULTS: During a median follow-up of 15 years, 264 stroke, 484 CHD, and 659 ASCVD events were observed. In fully adjusted models, ever use of MHT was associated with reduced risk of stroke (hazard ratio 0.86, 95% CI 0.76-0.98), CHD (0.85, 0.74-0.98), and ASCVD (0.83, 0.73-0.95) in white women with PreDM or T2DM. Early use of MHT was associated with reduced risk of stroke (0.82, 0.72-0.95), CHD (0.85, 0.74-0.98), and ASCVD (0.82, 0.70-0.96) in the white group. No risk reduction with ever or early use of MHT was found for black women with PreDM or T2DM. CONCLUSIONS: MHT is associated with statistically reduced CVD risk among white but not black women with PreDM or DM. Race is an effect modifier in the association between MHT use and CVD.
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