# Presentation: 517823

## Hormone Replacement Therapy: Friend or Foe?

**A Retrospective Study for Prospective Research**

**Research Alliance in Math and Science**
**Computational Sciences and Engineering, Oak Ridge National Laboratory**
**Mentor: Kara L. Kruse**
**http://wiki.ornl.gov/sites/rams/j_gauld**

- Acknowledgement of contributions to  research:		Oak Ridge National Laboratory: Sara Wezensky		University of Tennessee Medical Center:  Oscar Grandas, MD, Fernando Aycinena, MD, Melinda Klar, RN.

**Results and Conclusions**

**Future Research**

**Femoropopliteal Bypass and Intimal Hyperplasia**

- The Research Alliance in Math and Science program is sponsored by the Office of Advanced Scientific Computing Research, U.S. Department of Energy.  The work was performed at the Oak Ridge National Laboratory which is managed by UT-Battelle, LLC under Contract No. De-AC05-00OR22725. This work has been authored by a contractor of the U.S. Government, accordingly, the U.S. Government retains a nonexclusive, royalty-free license to publish or reproduce the published form of this contribution, or allow others to do so, for U.S. Government purposes.

**What is the problem?**

**Jillian Gauld**
**Queen’s University**

**Intimal Hyperplasia (IH) - universal response of an artery to injury**
**Procedures such as fem-pop bypass respond with an influx of cells from the media to the intima**
**IH causes ****restenosis****, or post-surgical narrowing of the artery, in 1/3 of cases**

**Atherosclerosis: hardening of arterial vessels characterized by chronic inflammation and deposition of fatty plaques**
**Risk factors include diabetes, smoking, high blood pressure, and obesity**
**Treatments include statin drugs, diets, lifestyle changes, and surgical interventions such as angioplasty and ****femoropopliteal (fem-pop) bypass**

**The Role of Hormone Replacement Therapy**

**Post-menopausal women on hormone replacement therapy (HRT) have more complications after fem-pop bypass than post-menopausal women without HRT**
**This clinical observation contradicts the accepted theory that estrogen has vascular protective effects**

**What Did I Work On?**

**Determined statistical significance of numerous medical risk factors in relation to graft patency and intimal hyperplasia**
**Used appropriate tests to find correlations between variables, including use of hormone replacement therapy, diabetes, and high blood pressure**
**Utilized Kaplan-Meier survival analysis, chi-square test for independence, student’s t-test, mosaic plot, scatter plot matrices**
**Used JMP software for statistical analyses**

**Kaplan-Meier analysis- patients on hormone replacement therapy have on average lower primary patency rates than patients not on HRT**
**Chi-square test for independence: few significant p-values were found**
**Reasons- small sample size: 68 patients**
**Significance found in relationship between mental and mood disorders and graft patency**

**Current study designed to assist in future prospective studies on HRT and graft patency**
**Help define parameters for future study: larger sample size, attention to mental and mood disorders**

|                         |
| --- |

**Primary Graft Patency Rates**

-  Non-HRT Patients
-  HRT Patients

**Mosaic Plot showing patency rates divided by the patients’ use of HRT**
**Demonstrates lower primary patency rates, and increased assisted patency in HRT patients**

- %

**Restenosis typically occurs in the distal astomosis, where the graft rejoins the artery. The toe, heel, and bed of the distal astomosis are the most common sites for intimal hyperplasia.**

**Kaplan-Meier analysis: cumulative primary patency rate over a ten year period**
**Shows lower primary patency rates in HRT patients**

**Chi-square analysis of mental and mood disorders vs. graft patency**
**P value= .0178**

**Statistical Analyses**

**http://www.irishscientist.ie**

**Normal Artery**

**Intimal Hyperplasia Present**

**Lumen**

**Intima**

**Intima**

**Lumen **

**In healthy vessels, the intima is only about one cell layer thick. When intimal hyperplasia occurs, smooth muscle cells move from the media to the intima. This occludes the lumen, which decreases arterial blood flow.**

| Count
Expected | Primary | Primary
Assisted | Secondary | Total |
| --- | --- | --- | --- | --- |
| No | 21
18.3492 | 3
7.55556 | 10
8.09524 | 34 |
| Yes | 13
15.6508 | 11
6.44444 | 5
6.90476 | 29 |
| Total | 34 | 14 | 15 | 63 |

**University of Tennessee Graduate School of Medicine**

**http://www.wikipedia.org**

**http://vasculardiseasemanagement.com/docs/goresupp.pdf**** **