Oral contraceptives, HRT linked to microalbuminuria

from medicontext.co.il

By Will Boggs, MD

WESTPORT, CT (Reuters Health) – The use of oral contraceptives or hormone replacement therapy is associated with an increased risk of microalbuminuria, according to a report in the September 10th Archives of Internal Medicine.

Microalbuminuria presages vascular endothelial damage and brings an increased risk of cardiovascular morbidity and mortality, the authors note. It has not been linked previously with the use of estrogens or progestins.

Hypothesizing that measurement of microalbuminuria might distinguish women who face a higher risk of cardiovascular events with hormonal therapy from those who do not, Dr. Wilbert M. T. Janssen and colleagues from the University of Groningen, in the Netherlands, studied the association between oral contraceptives (OCs) or hormone replacement therapy (HRT) and microalbuminuria in 3305 women, ages 28 to 75, participating in the Prevention of Renal and Vascular End Stage Disease Study.

In premenopausal women, OC use was significantly more prevalent (p < 0.05) in those with microalbuminuria than in those without, the authors report. In postmenopausal women, there was a similar, though insignificant, tendency toward greater use of HRT in the microalbuminuria group.

Oral contraceptive use in premenopausal women increased the risk of microalbuminuria by 90%, the researchers note, whereas HRT doubled the risk of microalbuminuria in postmenopausal women.

Postmenopausal women who used HRT for more than 5 years faced an increased risk of microalbuminuria compared with women who used HRT for fewer years. In premenopausal women, increasing estrogen content tended to enhance the risk of microalbuminuria, as did the use of second-generation instead of third-generation progestins.

"Because microalbuminuria is an early marker for increased risk of cardiovascular disease, users of estrogen preparations may have an increased risk for cardiovascular morbidity and mortality," the authors infer.

"We did not look at cardiovascular mortality and morbidity yet," Taco B. M. Monster, one of the researchers, told Reuters Health, "and therefore cannot say if differences in cardiovascular mortality and morbidity match our microalbuminuria findings."

The researcher added, "This is [just] one observational study. Before we start making decisions [about OCs or HRT] or change things, I would like to see other investigators finding similar results."

Arch Intern Med 2001;161:2000-2005.

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