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Hormone Replacement Therapy and Coronary Disease -- Strike 2

Results from the widely publicized Heart and Estrogen/progestin Replacement Study (HERS) showed that hormone replacement therapy (HRT) did not reduce the incidence of adverse coronary events among women with known coronary disease (see JW Sep 15 1998, p. 141, accession number 980828001, and JAMA 1998; 280:605). Now, findings of another multicenter U.S. study further weaken the case for HRT in secondary prevention.

Researchers enrolled 309 postmenopausal women (mean age, 66) with 1 or more coronary stenoses of 30 percent or more on angiography. The women were randomized to receive daily doses of conjugated estrogen (0.625 mg) plus medroxyprogesterone (2.5 mg), conjugated estrogen alone, or placebo. During an average follow-up of 3.2 years, HRT patients had significantly greater reductions in LDL cholesterol and increases in HDL cholesterol than did placebo recipients. Nevertheless, at follow-up angiography, average changes in coronary stenosis and diameter were not significantly different among the 3 groups. No subgroup appeared to benefit either from estrogen alone or from combined HRT. There were no significant differences between groups in numbers of adverse clinical events, but such events were infrequent given the sample size.

Comment: These results suggest that HRT does not affect the progression of coronary atherosclerosis in postmenopausal women with existing coronary lesions. Given these findings, and those of the 4-year HERS study, clinicians should not expect HRT to improve outcomes among women with coronary disease. Whether longer follow-up or earlier therapy would yield different results is unclear.

— AS Brett

Published in Journal Watch General Medicine September 1, 2000

Citation(s):

Herrington DM et al. Effects of estrogen replacement on the progression of coronary-artery atherosclerosis. N Engl J Med 2000 Aug 24 343 522-529.

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