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Healthy postmenopausal women undergo changes in lipoprotein and carbohydrate metabolism and in the pattern of body fat distribution similar to those of patients with diabetes. In fact, a picture resembling the metabolic syndrome emerges with the menopause (12). Replacement therapy with estrogen can improve the adverse impact of meno pause on lipid profile and bone mineral density, and there is evidence that estrogen may also improve carbohydrate metabolism and body fat distribution in healthy postmeno-pausal women (124-126). The role of HRT in preventing CVD in postmenopausal women, as discussed in detail in the first part of this chapter, remains highly controversial, but there is strong evidence that it may be beneficial in the early postmenopausal period and early stages of atherosclerosis.

Postmenopausal women with diabetes are at risk of dyslipidemia, central obesity, hypertension, and accelerated atherosclerosis, all of which can contribute to an increased risk of CVD (127). Thus, postmenopausal women with diabetes could benefit from a reduced risk of CVD with the use of HRT. However, whether HRT confers cardiovascular protection in postmenopausal women with diabetes is currently unknown and remains an issue for further clinical research.

An attempt is made in this section to shed some light in this issue based on current evidence. This is preceded by a brief review of the effects of estrogen on risk factors for diabetes and the metabolic syndrome in both nondiabetic and diabetic postmenopausal women.

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