Hormone replacement therapy, body mass index and asthma in perimenopausal women: a cross sectional survey

Real, F. Gómez; Svanes, C.; Björnsson, E. H.; Franklin, K.; Gislason, D.; Gislason, T.; Gulsvik, A.; Janson, C.; Jögi, R.; Kiserud, T.; Norbäck, D.; Nyström, L.; Torén, K.; Wentzel-Larsen, T.; Omenaas, E.
January 2006
Thorax;Jan2006, Vol. 61 Issue 1, p34
Academic Journal
Background: Hormone replacement therapy (HRT) and obesity both appear to increase the risk of asthma. A study was undertaken to investigate the association of HRT with asthma and hay fever in a population of perimenopausal women, focusing on a possible interaction with body mass index (BMI). Methods: A postal questionnaire was sent to population based samples in Denmark, Estonia, Iceland, Norway, and Sweden in 1999-2001, and 8588 women aged 25-54 years responded (77%). Pregnant women, women using oral contraceptives, and women <46 years were excluded. Analyses included 2206 women aged 46-54 years of which 884 were menopausal and 540 used HRT. Stratified analyses by BMI in tertiles were performed. Results: HRT was associated with an increased risk for asthma (OR 1.57 (95% Cl 1.07 to 2.30)), wheeze (OR 1.60 (95% Cl 1.22 to 2.10)), and hay fever (OR 1.48 (95% Cl 1.15 to 1.90)). The associations with asthma and wheeze were significantly stronger among women with BMI in the lower tertile (asthma OR 2.41 (95% Cl 1.21 to 4.77); wheeze OR 2.04 (95% Cl 1.23 to 3.36)) than in heavier women (asthma: Pinteraction=0.030 wheeze: Pinteraction=0.042). Increasing BMI was associated with more asthma (OR 1.08 (95% Cl 1.05 to 1.12) per kg/m²). This effect was only found in women not taking HRT (OR 1.10 (95% Cl 1.05 to 1.14) per kg/m²); no such association was detected in HRT users (OR 1.00 (95% Cl 0.92 to 1.08) per kg/m²) (Pinteraction= 0.046). Menopause was not significantly associated with asthma, wheeze, or hay fever. Conclusions: In perimenopausal women there is an interaction between HRT and BMI in the effects on asthma. Lean women who were HRT users had as high a risk for asthma as overweight women not taking HRT. It is suggested that HRT and overweight increase the risk of asthma through partly common pathways.


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