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More Discouraging HRT Results

These findings confirm that HRT and antioxidant therapy have no value in preventing or treating coronary disease in postmenopausal women.

Recent, updated data from the Heart Estrogen/progestin Replacement Study (HERS) showed that hormone replacement therapy (HRT) conferred no cardiovascular benefit in postmenopausal women with coronary disease (Journal Watch Jul 26 2002). Now, in yet another secondary-prevention study, researchers explored the effects of HRT, with or without concomitant antioxidant therapy, in 423 postmenopausal women (mean age, 65) with documented coronary stenoses based on angiography. The women were randomized to receive daily HRT (0.625-mg conjugated equine estrogen, plus 2.5-mg progesterone in those with intact uteri) or placebo; within these groups, the women were further randomized to receive twice-daily antioxidant therapy (400-IU vitamin E plus 500-mg vitamin C) or placebo.

Angiograms were performed at baseline and after a mean of 2.8 years. In an intent-to-treat analysis, the mean change in coronary-artery lumen diameter did not differ significantly among the groups. When women who suffered myocardial infarction or sudden cardiac death during the study were assigned worst-possible angiographic outcomes, HRT recipients fared significantly worse than did placebo recipients, and antioxidant recipients fared worse (although not significantly) than did placebo recipients.

Comment: This report seems to pile on more negative news about HRT: The results confirm previous data that show that HRT and antioxidant therapy have no value in preventing or treating coronary disease in postmenopausal women. In addition, HRT and antioxidant therapy -- alone or together -- might increase risk for clinical cardiac events.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine December 17, 2002

Citation(s):

Waters DD et al. Effects of hormone replacement therapy and antioxidant vitamin supplements on coronary atherosclerosis in postmenopausal women: A randomized controlled trial. JAMA 2002 Nov 20; 288:2432-40.

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