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Menopausal Hormone Therapy and Subclinical Cardiovascular Disease in Women With and Without Human Immunodeficiency Virus.

Authors :
Peters, Brandilyn A
Hanna, David B
Sharma, Anjali
Anastos, Kathryn
Hoover, Donald R
Shi, Qiuhu
Moran, Caitlin A
Jackson, Elizabeth A
Alcaide, Maria L
Ofotokun, Igho
Adimora, Adaora A
Haberlen, Sabina A
Cohen, Mardge
Tien, Phyllis C
Michel, Katherine G
Levine, Steven R
Hodis, Howard N
Kaplan, Robert C
Yin, Michael T
Source :
Clinical Infectious Diseases; 2/1/2023, Vol. 76 Issue 3, pe661-e670, 10p
Publication Year :
2023

Abstract

Background Estrogen-based hormone therapy (HT) may have beneficial cardiovascular effects when initiated in early menopause. This has not been examined in women with human immunodeficiency virus (HIV), who have heightened immune activation and cardiovascular risks. Methods Among 609 postmenopausal women (1234 person-visits) in the Women's Interagency HIV Study, we examined the relationship of ever HT use (oral, patch, or vaginal) with subclinical atherosclerosis: carotid artery intima-media thickness (CIMT), distensibility, and plaque assessed via repeated B-mode ultrasound imaging (2004–2013). We also examined associations of HT with cross-sectional biomarkers of immune activation and D-dimer. Statistical models were adjusted for sociodemographic, behavioral, and cardiometabolic factors. Results Women (mean age, 51 years; 80% HIV positive) who ever used HT at baseline were older, and more likely to be non-Hispanic White and report higher income, than never-users. Women who ever used HT had 43% lower prevalence of plaque (prevalence ratio, 0.57 [95% confidence interval {CI},.40–.80]; P <.01), 2.51 µm less progression of CIMT per year (95% CI, –4.60, to –.41; P =.02), and marginally lower incidence of plaque over approximately 7 years (risk ratio, 0.38 [95% CI,.14–1.03; P =.06), compared with never-users, adjusting for covariates; ever HT use was not associated with distensibility. These findings were similar for women with and without HIV. Ever HT use was associated with lower serum D-dimer, but not with biomarkers of immune activation after covariate adjustment. Conclusions HT may confer a subclinical cardiovascular benefit in women with HIV. These results begin to fill a knowledge gap in menopausal care for women with HIV, in whom uptake of HT is very low. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
10584838
Volume :
76
Issue :
3
Database :
Complementary Index
Journal :
Clinical Infectious Diseases
Publication Type :
Academic Journal
Accession number :
161829762
Full Text :
https://doi.org/10.1093/cid/ciac620