Significance: Hormonal and metabolic changes associated with the menopause may increase risk for cardiovascular disease (CVD). The postmenopausal period is associated with increases in total and central (""""""""android"""""""") body fat; increses in the atherogenic components of the blood lipid profile; and deterioration of glucose tolerance - all risk factors for CVD. Changes in lipid and glucose metabolism may be secondary to accumulation of central fat, particularly intra-abdominal fat (IAF), the compartment associated with dyslipidemia and insulin resistance. Hormone replacement therapy has positive effects on the lipid profile in postmenopausal women, reduces risk and incidence of CVD, and may affect regional fat deposition. The extent to which the beneficial effects of hormone therapy on disease risk are mediated by changes in fat distribution is not known. Few studies have examined the effects of hormone therapy on body composition and fat distribution, and none have examined the effect of exogenous hormones on IAF, the adipose compartment most closely associated with disease risk. The present study will test the hypothesis that hormone replacement therapy (HRT, combined estrogen-progestin) decreases disease risk by limiting IAF deposition. The proposed research will examine the effect of HRT on total, regional, and intra-abdominal fat deposition, and on the relationships between adiposity, the plasma lipid profile, and glucose metabolism.
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