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Rachel Whitmer,
PhD, School of Public Health, University of California Berkeley, Berkeley,
CA
The associations between Hormone Replacement Therapy (HRT), cardiovascular
risk factors (CVD), and cognitive performance were explored in a community
sample of 1049 postmenopausal Latinas from an observational cohort
study (mean age 70.3). Twenty one-percent of women were using HRT.
Multiple regression models were done to examine if HRT modified the
effect of CVD on the Modified Minimental State Exam (3MSE) and a measure
of verbal episodic memory (VM). Those using HRT had significantly
higher scores on both cognitive measures (p<.0001), and this association
was not confounded by disease history, nutritional factors, hysterectomy
status, blood pressure or lipids. Also, those using HRT had lower
LDL and homocysteine, and higher levels of triglycerides and HDL (p<.0001)
Homocysteine and systolic blood pressure were inversely associated
with both cognitive measures (p<.0001). The association between homocysteine
and cognitive performance was not reduced by adjustment for creatinine,
B12 and folate (p<.0001). Interaction terms of Homocysteine by HRT
were significantly associated with both the 3MSE and the VM such that
the inverse association between Homocysteine and cognition was only
among those not using HRT. This effect remained after adjustment of
lipids, creatinine, B12, and folate (p< .0001). Adjustment for acculturation,
age, education and income reduced the magnitude of the effect, although
it was still significantly associated with both cognitive measures
(p <.001). These results suggest that homocysteine may be one mechanism
through which HRT affects cognitive performance.
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