Estrogen treatment improves arterial distensibility, fibrinolysis, and metabolic profile in postmenopausal women with type 2 diabetes mellitus.
The effects of isolated estrogen therapy on the hemostatic system and arterial distensibility were determined in postmenopausal females with type 2 diabetes mellitus. This was a prospective nonrandomized study of 19 subjects (age, 56.2 +/- 4.7 years; body mass index, 27.8 +/- 2.4 kg/m(2) [mean +/- SD]). Inclusion was done after 2 months of glycemic and blood pressure control. The study consisted of 4 months of placebo treatment immediately followed by an equal period of oral conjugated equine estrogens (CEE) 0.625 mg/d. Measures included anthropometrics, a metabolic profile (oral glucose tolerance test and fasting glycated hemoglobin, total cholesterol and fractions, and triglyceride levels), and coagulation and fibrinolytic factors at the end of the placebo period and after 4 months of oral CEE. Conjugated equine estrogen therapy decreased plasminogen activator inhibitor 1 (placebo x CEE: 16.33 +/- 9.11 x 13.08 +/- 8.87 UI/mL, P < .03) and increased factor VIII activity (134.11% +/- 46.18% x 145.33% +/- 42.04%, P < .04). An increase in high-density lipoprotein cholesterol levels (placebo x CEE: 42.47 +/- 6.80 x 53.32 +/- 11.89 mg/dL, P < .01), and a decrease in glycated hemoglobin (8.45% +/- 1.30% vs 7.58% +/- 1.06%, P < .02) and in fasting glucose levels (121.51 +/- 21.05 x 111.21 +/- 20.74 mg/dL, P = .02) followed CEE therapy. Pulse wave velocity and augmentation index were performed by applanation tonometry and were obtained at the end of the placebo period (placebo), again after an intravenous load of 1.25 mg of CEE (short-term), and after 4 months of oral CEE (long-term). A significant decrease in central (carotid-femoral) pulse wave velocity was seen both after short- and long-term CEE (placebo vs short-term vs long-term: 9.36 +/- 2.58 vs 8.26 +/- 2.20 vs 7.98 +/- 1.90 m/s, respectively [analysis of variance, P < .03]; placebo vs short-term, P < .05; placebo vs long-term, P < .01), whereas augmentation index decreased only after long-term CEE (placebo vs short-term vs long-term: 39.14% +/- 6.94% vs 37.48% +/- 8.67% vs 34.3.3% +/- 8.11% [analysis of variance, P < .05], respectively; placebo vs long-term, P < .05). Long-term administration of CEE leads to an improvement in fibrinolysis and arterial distensibility, associated with an increase of the intrinsic coagulation pathway in postmenopausal women with type 2 diabetes mellitus.
Sztejnsznajd
Claudia
C
Laboratory of Medical Investigation LIM-18, Gynecology Department, Fundação Pró-Sangue Hemocentro-SP, São Paulo, SP, Brazil. doctoreg@uol.com.br
Silva
Maria Elizabeth Rossi
ME
da Silva
Maria Elizabeth Rossi
ME
Nussbacher
Amit
A
Gebara
Otavio Eluf
OE
D'Amico
Elbio Antônio
EA
Rocha
Dalva Marriero
DM
da Rocha
Tania Rubia Flores
TR
Santos
Rosa Ferreira
RF
dos Santos
Rosa Ferreira
RF
Wajngarten
Maurício
M
Fukui
Rosa Tesumechiro
RT
Correia
Márcia Regina Soares
MR
Wajchenberg
Bernardo Leo
BL
Ursich
Mileni Josefina Maria
MJ
D001158:Arteries / Q000187:drug effects* / Q000503:physiopathology; D002784:Cholesterol / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism*; D004966:Estrogens, Conjugated (USP) / Q000494:pharmacology*; D005169:Factor VIII / Q000032:analysis; D005342:Fibrinolysis / Q000187:drug effects*; D005951:Glucose Tolerance Test; D006801:Humans; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D017698:Postmenopause / Q000378:metabolism*
D004966:Estrogens, Conjugated (USP); D017395:Plasminogen Activator Inhibitor 1; D005169:Factor VIII; D002784:Cholesterol