Vascular effects of estrogen in type II diabetic postmenopausal women

Objectives We assessed the effects of estrogen on vascular dilatory and other homeostatic functions potentially affected by nitric oxide (NO)-potentiating properties in type II diabetic postmenopausal women. Background There is a higher cardiovascular risk in diabetic women than in nondiabetic women. This would suggest that women with diabetes do not have the cardioprotection associated with estrogen. Methods We administered placebo or conjugated equine estrogen, 0.625 mg/day for 8 weeks, to 20 type II diabetic postmenopausal women in a randomized, double-blinded, placebo-controlled, cross-over design. Results Compared with placebo, estrogen tended. to lower low-density lipoprotein (LDL) cholesterol levels by 15 +/- 23% (p=0.007) and increase high-density lipoprotein (HDL) cholesterol levels by 8 +/- 16% (p=0.034). Thus, the ratio of LDL to HDL cholesterol levels significantly decreased with estrogen, by 20 +/- 24%, as compared with placebo (p=0.001). Compared with placebo, estrogen tended to increase triglyceride levels by 16 +/- 48% and tower glycosylated hemoglobin levels by 3 +/- 13% (p=0.295 and p=0.199, respectively). However, estrogen did not significantly improve the percent flow-mediated dilatory response to hyperemia (17 +/- 75% vs. placebo; p=0.501). The statistical power to accept our observation was 81.5%. Compared with placebo, estrogen did not significantly change E-selectin, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, monocyte chemoattractant protein-1 or matrix metalloproteinase-9 levels. Compared with placebo, estrogen tended to decrease tissue factor antigen and increase tissue factor activity levels by 7 +/- 46% and 5 +/- 34%, respectively (p=0.321 and p=0.117, respectively) and lower plasminogen activator inhibitor-1 levels by 16 +/- 31% (p=0.043). Conclusions The effects of estrogen on endothelial, vascular dilatory and other homeostatic functions were less apparent in type II diabetic postmenopausal women, despite the beneficial effects of estrogen on lipoprotein levels. (J Am Coll Cardiol 2001;38:1409-15) (C) 2001 by the American College of Cardiology.