NYMC Faculty Publications

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

Brandilyn A. Peters, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
David B. Hanna, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
Anjali Sharma, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
Kathryn Anastos, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
Donald R. Hoover, Department of Statistics and Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA.
Qiuhu Shi, School of Health Sciences and Practice, New York Medical College, Valhalla, New York, USA.
Caitlin A. Moran, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Elizabeth A. Jackson, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Maria L. Alcaide, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
Igho Ofotokun, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Adaora A. Adimora, Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Sabina A. Haberlen, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Mardge Cohen, Department of Medicine, Stroger Hospital, Cook County Health and Hospital System, Chicago, Illinois, USA.
Phyllis C. Tien, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Katherine G. Michel, Department of Medicine, Georgetown University, Washington, District of Columbia, USA.
Steven R. Levine, Departments of Neurology and Emergency Medicine, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA.
Howard N. Hodis, 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, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
Michael T. Yin, Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA.

Author Type(s)

Faculty

Journal Title

Clinical Infectious Diseases

First Page

e661

Last Page

e670

Document Type

Article

Publication Date

2-8-2023

Department

Public Health

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.

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