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

Humans Female Middle Aged Carotid Intima-Media Thickness Cardiovascular Diseases / epidemiology HIV Cross-Sectional Studies Menopause HIV Infections / complications Biomarkers Risk Factors
HIV atherosclerosis cardiovascular disease hormone therapy menopause

Journal

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213

Informations de publication

Date de publication:
08 02 2023
Historique:
received: 14 04 2022
pubmed: 30 7 2022
medline: 11 2 2023
entrez: 29 7 2022
Statut: ppublish

Résumé

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. 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. 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. 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.

Sections du résumé

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.

Identifiants

DOI: 10.1093/cid/ciac620 PMID: 35903868 PMC: PMC10169435
pubmed: 35903868
pii: 6651468
doi: 10.1093/cid/ciac620
pmc: PMC10169435
doi:

Substances chimiques

Biomarkers 0

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e661-e670

Subventions

Organisme : NIAID NIH HHS
ID : P30 AI027767
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI050409
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI031834
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146245
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146208
Pays : United States
Organisme : NHLBI NIH HHS
ID : K01 HL160146
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR001432
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146192
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI069470
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI073961
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146202
Pays : United States
Organisme : NIA NIH HHS
ID : R21 AG060860
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL146194
Pays : United States
Organisme : NIMH NIH HHS
ID : P30 MH116867
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069470
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001881
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000004
Pays : United States
Organisme : NHLBI NIH HHS
ID : K01 HL137557
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23 HL152903
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR003098
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI050410
Pays : United States

Informations de copyright

© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Déclaration de conflit d'intérêts

Potential conflicts of interest. P. C. T. has received research funding from Merck (paid to institution) and Gilead to conduct sponsor-initiated clinical trials, unrelated to the current manuscript; grants or contracts (paid to institution), outside the submitted work, from Lilly; and royalties paid to self from UpToDate. A. A. A. has received consulting fees from Merck and Gilead; Merck and Gilead have also provided her institution with funding for her research. H. N. H. reports grants or contracts from the NIA, NIH (R01-AG059690 and R01-AG058691) and the Institute of Environmental Health, NIH (R01-ES031590), all outside the submitted work; payment or honoraria for a keynote lecture on menopause from the American Society of Reproductive Medicine; and data and safety monitoring board (DSMB) Chair, Flushing Reduction Associated With Nitrates (R01-AG050588) and DSMB for NIA-funded project (concluded). E. A. J. reports grants or contracts from the NIH outside the submitted work; royalties or licenses from UpToDate; consulting fees from the American College of Cardiology and McKesson; payment for expert testimony from DeBalse, Brown, Everly, LLP; and participation on a DSMB or advisory board for the NIH. K. A. reports additional grants from the NIH (paid to institution), outside the submitted work, and support for attending meetings and/or travel from the NIH (paid to institution). M. T. Y. reports support for the present manuscript from National Institute of Allergy and Infectious Diseases (K24 AI155230). M. L. A. reports grants or contracts from NIH MWCCS, outside the submitted work. A. S. reports grant funding from Gilead Sciences, outside the submitted work, and consulting fees from Gilead Sciences. I. O. reports grants or contracts from Merck, outside the submitted work. D. B. H. reports grants or contracts from the NIH (paid to institution), outside of the submitted work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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Auteurs

Brandilyn A Peters (BA)

Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
ORCID: 0000-0002-1534-2578

David B Hanna (DB)

Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.

Anjali Sharma (A)

Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.

Kathryn Anastos (K)

Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.

Donald R Hoover (DR)

Department of Statistics and Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA.

Qiuhu Shi (Q)

School of Health Sciences and Practice, New York Medical College, Valhalla, New York, USA.

Caitlin A Moran (CA)

Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.

Elizabeth A Jackson (EA)

Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Maria L Alcaide (ML)

Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.

Igho Ofotokun (I)

Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.

Adaora A Adimora (AA)

Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Sabina A Haberlen (SA)

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

Mardge Cohen (M)

Department of Medicine, Stroger Hospital, Cook County Health and Hospital System, Chicago, Illinois, USA.

Phyllis C Tien (PC)

Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Department of Veterans Affairs Medical Center, San Francisco, California, USA.

Katherine G Michel (KG)

Department of Medicine, Georgetown University, Washington, District of Columbia, USA.

Steven R Levine (SR)

Departments of Neurology and Emergency Medicine, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA.

Howard N Hodis (HN)

Departments of Medicine and Population and Public Health Sciences, Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.

Robert C Kaplan (RC)

Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington, USA.

Michael T Yin (MT)

Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA.

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Classifications MeSH

Recherchemedicale.com › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Menopausal Hormone Therapy and Subclinical...
Recherchemedicale.com › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Menopausal Hormone Therapy and Subclinical...
Recherchemedicale.com › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Épaisseur intima-média carotidienne › Menopausal Hormone Therapy and Subclinical...
Recherchemedicale.com › Maladies cardiovasculaires › Menopausal Hormone Therapy and Subclinical...
Recherchemedicale.com › Virus › Virus à ARN › Retroviridae › Lentivirus › Lentivirus des primates › VIH (Virus de l'Immunodéficience Humaine) › Menopausal Hormone Therapy and Subclinical...
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Recherchemedicale.com › Maladies du système immunitaire › Déficits immunitaires › Infections à VIH › Menopausal Hormone Therapy and Subclinical...
Recherchemedicale.com › Facteurs biologiques › Marqueurs biologiques › Menopausal Hormone Therapy and Subclinical...
Recherchemedicale.com › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Menopausal Hormone Therapy and Subclinical...