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Is Hormone Therapy Beneficial for Women with Known CAD?

A compelling reason for postmenopausal women to consider hormone replacement therapy (HRT) is to reduce their risk for coronary artery disease. However, the supporting evidence is derived primarily from nonrandomized observational studies, which may have been biased if healthier women chose to take HRT. This blinded multicenter trial evaluated the effects of daily estrogen (0.625 mg) plus medroxyprogesterone acetate (2.5 mg) against placebo in 2,763 randomized, postmenopausal women (mean age, 67 years) with known coronary disease and an intact uterus.

During an average follow-up of four years, hormone therapy had a beneficial effect on lipid levels, but cardiovascular outcomes between the two groups did not differ overall. Women receiving HRT had more coronary events in year 1 of the study, and fewer in years 4 and 5. Rates of cancer and total mortality were similar, but the women receiving HRT had a significant increase in thromboembolic events (34 vs. 12 events) and gallbladder disease (84 vs. 62 episodes).

Comment: This important study calls into question whether hormone therapy actually reduces coronary events in women with preexisting coronary disease, but it does not definitively preclude such effects. The trend toward fewer coronary events with HRT in the later years of the study suggests that long-term treatment may be needed to produce benefits that outweigh early harms. Finally, these findings are not necessarily applicable to primary prevention in women without known coronary disease.

— TH Lee

Published in Journal Watch General Medicine August 28, 1998

Citation(s):

Hulley S et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 1998 Aug 19 280 605-613.

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