Hormone replacement therapy in postmenopausal women protects against smoking-induced changes in vascular structure and function

OBJECTIVES The purpose of this study was to investigate the role of hormone replacement therapy (HRT) in postmenopausal women who smoke. BACKGROUND Hormone replacement therapy appears to afford cardiovascular protection in postmenopausal women; however, in high risk individuals, specifically smokers, this has not been adequately studied. This question was addressed in cross-sectional study of arterial structure, function and plasm lipids in postmenopausal smokers and nonsmokers. METHODS Vascular ultrasound was performed in two age-matched groups of postmenopausal women, 70 on HRT (35 smokers) and 70 control subjects not on HRT (35 smokers). Indexes of arterial structure (carotid intima–medi thickness [IMT]) and vascular function (systemic arterial compliance [SAC]) and lipid profiles were measured. RESULTS Participant characteristics were similar in the two groups. Smokers on HRT, compared with smoking control subjects, had lower cholesterol (6.0 ± 0.2 vs. 6.8 ± 0.3 mmol/liter, p = 0.03) and more favorable mean values for IMT (0.64 ± 0.02 vs. 0.74 ± 0.03 mm, p = 0.007) and SAC (0.41 ± 0.03 vs. 0.32 ± 0.03 U/mm Hg, p = 0.03). Nonsmokers on HRT compared with nonsmoking control subjects had lower total cholesterol (5.7 ± 0.2 vs. 6.5 ± 0.2 mmol/liter, p = 0.02) and low density lipoprotein cholesterol (3.4 ± 0.2 vs. 4.4 ± 0.3 mmol/liter, p = 0.01). Mean IMT and SAC values in nonsmokers on HRT and control subjects were not significantly different. Multiple regression demonstrated significant correlation between HRT status and both IMT and SAC, in smokers and in those with increased cholesterol. In nonsmokers and those with lower cholesterol, HRT status was not significantly correlated with vascular parameters. CONCLUSIONS In postmenopausal women who smoke there may be beneficial effect of long-term estrogen therapy on indexes of arterial structure and function as surrogate markers of cardiovascular disease. Long-term controlled studies are needed to confirm these findings.