title: Insulin sensitivity in women with coronary heart disease during hormone replacement therapy.
abstract: OBJECTIVE
  The aim of the present study was to evaluate the effect on insulin secretion and insulin sensitivity of hormone replacement therapy (HRT) with short-term unopposed transdermal 17beta-estradiol and, after 1 year, when combined with intermittent medroxyprogesterone acetate (MPA).
  
  
  METHODS
  Ninety-nine postmenopausal women with coronary artery disease (CAD), but without diabetes mellitus, consecutively recruited from patients referred for invasive coronary investigations at a tertiary university clinic, were randomized to either HRT or a control group. Unopposed estradiol was given for 3 months, and MPA was added in cycles of 14 days every 3 months. Clinical investigations were undertaken at baseline and after 3 months and 12 months. Insulin sensitivity index (HOMA-IR) and insulin secretion (HOMA-BCF) were calculated using the homeostasis model assessment.
  
  
  RESULTS
  Compared with the control group, treatment with unopposed transdermal 17beta-estradiol caused a significant decrease in HOMA-IR, that is, improved insulin sensitivity, but after combination with MPA and 12 months of HRT, no change was observed in HOMA-IR. Similarly, a transient decrease was observed for plasma levels of C peptide after unopposed 17beta-estradiol. HOMA-BCF remained unchanged throughout the study period. Sex hormone-binding globulin (SHBG) was related to HOMA-IR but not to HOMA-BCF at baseline. The association with HOMA-IR grew stronger after unopposed transdermal estradiol. No deleterious effect of HRT on glucose metabolism was found in postmenopausal women with CAD.
  
  
  CONCLUSIONS
  Short-term treatment with unopposed transdermal estradiol caused a decrease in insulin resistance, but long-term treatment after intermittent MPA was introduced had no effect on either insulin secretion or insulin resistance.
authors.affiliation: Department of Pharmacotherapeutics, University of Oslo, Oslo, Norway. ingrid.os@medisin.uio.no
authors.forename: Ingrid
authors.initials: I
authors.lastname: Os
authors.forename: Audun
authors.initials: A
authors.lastname: Os
authors.forename: Michael
authors.initials: M
authors.lastname: Abdelnoor
authors.forename: Anne
authors.initials: A
authors.lastname: Larsen
authors.forename: Kåre
authors.initials: K
authors.lastname: Birkeland
authors.forename: Arne
authors.initials: A
authors.lastname: Westheim
mesh_terms: D000368:Aged; D003327:Coronary Disease; D004305:Dose-Response Relationship, Drug; D004958:Estradiol / Q000008:administration & dosage* / Q000009:adverse effects; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood* / Q000378:metabolism; D007333:Insulin Resistance; D000078790:Insulin Secretion; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009664:Norway; D017698:Postmenopause / Q000187:drug effects; D013997:Time Factors; D016387:Women's Health
chemical_list: D007328:Insulin; D004958:Estradiol; D017258:Medroxyprogesterone Acetate