Hormone therapy within 10 years of menopause and CHD risk

January 01, 0001

Hormone therapy within 10 years of menopause and CHD risk

Estrogen plus progestin therapy increases the risk for coronary heart disease (CHD) in postmenopausal women. However, this increased risk might be limited to the first years of use and to women who start therapy late in menopause. These US authors estimated the effect of continuous estrogen plus progestin therapy on CHD risk over time and stratified by years since menopause using data from the Women's Health Initiative randomized, double-blinded, placebo-controlled trial. Intervention consisted of daily administration of conjugated equine estrogens, 0.625 mg/d, plus medroxyprogesterone acetate, 2.5 mg/d, or placebo.

They found: "Compared with no use of hormone therapy, the hazard ratio for continuous use of estrogen plus progestin therapy was 2.36 for the first 2 years and 1.69 for the first 8 years. For women within 10 years after menopause, the hazard ratios were 1.29 (NS)for the first 2 years and 0.64 (NS) for the first 8 years, and the CHD-free survival curves for continuous use and no use of estrogen plus progestin crossed at about 6 years.The analysis may not have fully adjusted for joint determinants of adherence and CHD risk. Sample sizes for some subgroup analyses were small."

The authors concluded: "No suggestion of a decreased risk for CHD was found within the first 2 years of estrogen plus progestin use, including in women who initiated therapy within 10 years after menopause. A possible cardioprotective effect in these women who initiated therapy closer to menopause became apparent only after 6 years of use."

The bottom line was that there was no significant increase or decrease in coronary heart disease risk for women initiating hormone therapy within 10 years after menopause.

For the full abstract, click here.

Ann Intern Med 152(4):211-217, 16 February 2010
© 2010 to the American College of Physicians
Coronary Heart Disease in Postmenopausal Recipients of Estrogen Plus Progestin Therapy-Does the Increased Risk Ever Disappear? A Randomized Trial. Sengwee Toh, Sonia Hernández-Díaz, Roger Logan, Jacques E. Rossouw, and Miguel A. Hernán. Correspondence to Dr. Toh: [email protected]

Category: K. Circulatory. Keywords: postmenopausal hormone therapy, conjugated equine estrogens, medroxyprogesterone, coronary heart disease risk, Women’s Health Initiative, secondary analysis of randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 2 March 2010

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