Year: 2015
Type: article
Abstract: OBJECTIVE: To examine whether the effect of postmenopausal hormone therapy (HT) on brain volumes in women aged 65-79 years differs depending on type 2 diabetes status during postintervention follow-up of a randomized controlled clinical trial. METHODS: The Women's Health Initiative randomized clinical trials assigned women to HT (0.625 mg/day conjugated equine estrogens with or without 2.5 mg/day medroxyprogesterone acetate) or placebo for an average of 5.6 years. A total of 1,402 trial participants underwent brain MRI 2.4 years after the trials; these were repeated in 699 women 4.7 years later. General linear models were used to assess the interaction between diabetes status and HT assignment on brain volumes. RESULTS: Women with diabetes at baseline or during follow-up who had been assigned to HT compared to placebo had mean decrement in total brain volume of -18.6 mL (95% confidence interval [CI] -29.6, -7.6). For women without diabetes, this mean decrement was -0.4 (95% CI -3.8, 3.0) (interaction p=0.002). This interaction was evident for total gray matter (p<0.001) and hippocampal (p=0.006) volumes. It was not evident for changes in brain volumes over follow-up or for ischemic lesion volumes and was not influenced by diabetes duration or oral medications. CONCLUSIONS: For women aged 65 years or older who are at increased risk for brain atrophy due to type 2 diabetes, prescription of postmenopausal HT is associated with lower gray matter (total and hippocampal) volumes. Interactions with diabetes and insulin resistance may explain divergent findings on how estrogen influences brain volume among older women.
Source: Neurology
Authors: Mark A. Espeland, Roberta Diaz Brinton, JoAnn E. Manson, Kristine Yaffe, Christina Hugenschmidt, Leslie Vaughan, Suzanne Craft, Beatrice J. Edwards, Ramon Casanova, Kamal Masaki, Susan M. Resnick, For the WHIMS-MRI2 Study Group, Sally Shumaker, Laura Coker, Claudine Legault, Steve Rapp, Maggie Dailey, Debbie Felton, Lee Ann Gleiser, Lisa Desiderio, Sylvia Wassertheil-Smoller, Mimi Goodwin, Jane Morley Kotchen, John Ulmer, Tracy Matusewic, Sally Dellenbach, Holly Loebel, Marcia Stefanick, Sherrill Downey, Rebecca Jackson, Amanda Kochis, John Robbins, Sophia Zaragoza, Lauren Nathan, Adele Perryman, Marian Limacher, Mary Ellen Toombs, Candy Clarke, Judith Ockene, Linda Churchill, Sharon Jackson, Deidre Sepavich, Richard Grimm, Chip Truwitt, Alexa Camarena, Robert Brunner, Jane Hammons, Carol Murphy, Stephanie Johnson, Angela Nauth, Kim Lucas
Institutions: University of Southern California, University of Hawaiʻi at Mānoa, Atrium Health Wake Forest Baptist, Brigham and Women's Hospital, National Institutes of Health, The University of Texas MD Anderson Cancer Center, Harvard University, University of California, San Francisco, National Institute on Aging, Wake Forest University Health Sciences, Wake Forest University, University of Hawaii System
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W1849999360