Postmenopausal estrogens and risk of myocardial infarction in diabetic women.
OBJECTIVE
The effect of hormone replacement therapy on the risk of myocardial infarction in diabetic women has not been well studied. We conducted a case-control study of postmenopausal estrogen use and risk of incident myocardial infarction (MI) in pharmacologically treated diabetic women enrolled at Group Health Cooperative of Puget Sound, a large health maintenance organization in the state of Washington.


METHODS
Case subjects (n = 212) were all postmenopausal women with treated diabetes who sustained an incident fatal or nonfatal MI between July 1986 and December 1994. Control subjects (n = 122) were treated diabetic women drawn from a stratified random sample of postmenopausal women without prior MI. Computerized pharmacy data and medical records were used to measure use of estrogens. Cardiovascular risk factors recorded from medical records, computerized pharmacy and laboratory data, and telephone interviews were used as adjustment variables.


RESULTS
In this study 8.5% of case and 13.9% of control subjects were current users of estrogens. The relative risk (RR) of MI for current estrogen users was 0.51 (95% CI 0.22-1.15) relative to never users, adjusted for age, study year, weight, angina, and duration of treated diabetes. Among current estrogen users, risk of MI tended to decline with each additional year of estrogen use (adjusted RR = 0.78, 95% CI 0.56-1.08). Of those studied, 45.3% of case and 37.7% of control subjects were past users of estrogens (adjusted RR = 1.22, 95% CI 0.71-2.09).


CONCLUSIONS
This study suggests that use of postmenopausal estrogens does not increase risk of MI in diabetic women and that sustained use may be of benefit.
Kaplan
R C
RC
Cardiovascular Health Research Unit, University of Washington, Seattle 98101, USA. rkaplan@u.washington.edu
Heckbert
S R
SR
Weiss
N S
NS
Wahl
P W
PW
Smith
N L
NL
Newton
K M
KM
Psaty
B M
BM
D000367:Age Factors; D000368:Aged; D000789:Angina, Unstable; D001806:Blood Urea Nitrogen; D015992:Body Mass Index; D001835:Body Weight / Q000187:drug effects; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D004967:Estrogens / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000150:complications / Q000453:epidemiology; D017698:Postmenopause; D011372:Progestins / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D013997:Time Factors; D014861:Washington / Q000453:epidemiology
D002784:Cholesterol; D003404:Creatinine; D004967:Estrogens; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D011372:Progestins