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Hormone Therapy, Age, and Risk for Heart Disease

Hormone therapy use soon after menopause does not seem to confer increased risk for CHD.

Women’s Health Initiative (WHI) data have suggested that the greatest risk for coronary heart disease associated with hormone therapy — with conjugated equine estrogen (CEE) alone or CEE plus medroxyprogesterone acetate (MPA) — might occur in older women. Because the number of younger women with CHD events was small, the WHI researchers pooled data from both arms of the trial, encompassing a total of 27,347 women aged 50 to 79 who were randomized to CEE or CEE/MPA (depending on uterine status) or placebo.

There was a slight, nonsignificant trend toward decreased CHD risk with HT use (compared with placebo) among younger women and those closer to menopause. For example, there was an absolute decrease of 6 CHD events per 10,000 person-years in women within 10 years of menopause, compared with an absolute increase in risk of 17 events for women 20 or more years since menopause, and a decrease of 2 events per 10,000 person-years for women aged 50 to 59, compared with an increase of 19 events for women aged 70 to 79. The trend toward decreased CHD risk in the early years after menopause was driven mainly by event rates in the CEE-alone arm (and not the CEE/MPA arm). Risk for stroke increased significantly across all categories of age and time since menopause (absolute increase, 9 events per 10,000 person-years).

Comment: The trend for CHD seen in these analyses, although nonsignificant, supports the current practice of many clinicians, who counsel patients that HT to control postmenopausal symptoms appears to be acceptable (in terms of CHD risk) for a few years but should then be stopped unless the symptoms are unmanageable. Of course, other risks associated with HT (breast cancer, stroke, and venous thrombosis) also should be kept in mind.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine April 10, 2007

Citation(s):

Rossouw JE et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA 2007 Apr 4; 297:1465-77.

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