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Estrogen/Progestin Replacement in Older Women with Coronary Disease: No Benefit

Additional follow-up data from HERS show no cardiovascular benefit from hormone replacement therapy in older women with coronary disease.

In the blinded, randomized, 4.1-year Heart and Estrogen/progestin Replacement Study (HERS), researchers found no overall reduction in coronary events among postmenopausal women (mean age, 67) with coronary disease who received daily estrogen and progestin (Journal Watch Aug 28 1998). In 2 reports from an unblinded follow-up study (mean, 2.7 years of additional follow-up), investigators analyzed results for more than 2300 of the original 2763 women who participated in HERS.

No significant decreases were noted in rates of coronary events or secondary cardiovascular events among women who took hormones compared with those who took placebo, even after adjustment for confounders, including differing use of statins. During the entire 6.8 years of therapy, hormone recipients had a significant increase in risk for any thromboembolic event and for biliary-tract surgery (relative hazard, 2.08 and 1.48, respectively). Hormone recipients were somewhat more likely to suffer hip fractures than were placebo recipients (P=0.06). Cancer incidence was similar in the 2 groups; death rates were high and did not differ between groups.

Comment: These data strongly suggest that hormone replacement therapy confers no cardiovascular benefit in women with known coronary disease. However, the older women with coronary disease in this study differ markedly from the younger, healthier women who typically are treated with hormone replacement at menopause. Such younger, healthier women were among those included in the study population of the Women's Health Initiative, the results of which have just been published (Journal Watch Jul 26 2002).

— Robert W. Rebar, MD

Published in Journal Watch General Medicine July 26, 2002

Citation(s):

Grady D et al. Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA 2002 Jul 3; 288:49-57.

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• Medline abstract (Free)

Hulley S et al. Noncardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA 2002 Jul 3; 288:58-66.

• Original article (Subscription may be required)
• Medline abstract (Free)