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      Hormone therapy for preventing cardiovascular disease in post-menopausal women

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          Abstract

          Evidence from systematic reviews of observational studies suggests that hormone therapy may have beneficial effects in reducing the incidence of cardiovascular disease events in post-menopausal women, however the results of randomised controlled trials (RCTs) have had mixed results. This is an updated version of a Cochrane review published in 2013.

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          Hormone therapy to prevent disease and prolong life in postmenopausal women.

          Deborah Grady (1992)
          To critically review the risks and benefits of hormone therapy for asymptomatic postmenopausal women who are considering long-term hormone therapy to prevent disease or to prolong life. Review of the English-language literature since 1970 on the effect of estrogen therapy and estrogen plus progestin therapy on endometrial cancer, breast cancer, coronary heart disease, osteoporosis, and stroke. We used standard meta-analytic statistical methods to pool estimates from studies to determine summary relative risks for these diseases in hormone users and modified lifetable methods to estimate changes in lifetime probability and life expectancy due to use of hormone regimens. There is evidence that estrogen therapy decreases risk for coronary heart disease and for hip fracture, but long-term estrogen therapy increases risk for endometrial cancer and may be associated with a small increase in risk for breast cancer. The increase in endometrial cancer risk can probably be avoided by adding a progestin to the estrogen regimen for women who have a uterus, but the effects of combination hormones on risk for other diseases has not been adequately studied. We present estimates for changes in lifetime probabilities of disease and life expectancy due to hormone therapy in women who have had a hysterectomy; with coronary heart disease; and at increased risk for coronary heart disease, hip fracture, and breast cancer. Hormone therapy should probably be recommended for women who have had a hysterectomy and for those with coronary heart disease or at high risk for coronary heart disease. For other women, the best course of action is unclear.
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            A prospective, observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease.

            F Speizer, Jonathan W. Willett, G. A. Colditz … (2000)
            Most primary prevention studies have found that long-term users of postmenopausal hormone therapy are at lower risk for coronary events, but numerous questions remain. An adverse influence of hormone therapy on cardiovascular risk has been suggested during the initial year of use; however, few data are available on short-term hormone therapy. In addition, the cardiovascular effects of daily doses of oral conjugated estrogen lower than 0.625 mg are unknown, and few studies have examined estrogen plus progestin in this regard. To investigate duration, dose, and type of postmenopausal hormone therapy and primary prevention of cardiovascular disease. Prospective, observational cohort study. Nurses' Health Study, with follow-up from 1976 to 1996. 70 533 postmenopausal women, in whom 1258 major coronary events (nonfatal myocardial infarction or fatal coronary disease) and 767 strokes were identified. Details of postmenopausal hormone use were ascertained by using biennial questionnaires. Cardiovascular disease was established by using a questionnaire and was confirmed by medical record review. Logistic regression models were used to calculate relative risks and 95% CIs, adjusted for confounders. When all cardiovascular risk factors were considered, the risk for major coronary events was lower among current users of hormone therapy, including short-term users, compared with never-users (relative risk, 0.61 [95% CI, 0.52 to 0.71]). Among women taking oral conjugated estrogen, the risk for coronary events was similarly reduced in those currently taking 0.625 mg daily (relative risk, 0.54 [CI, 0.44 to 0.67]) and those taking 0.3 mg daily (relative risk, 0.58 [CI, 0. 37 to 0.92]) compared with never-users. However, the risk for stroke was statistically significantly increased among women taking 0.625 mg or more of oral conjugated estrogen daily (relative risk, 1.35 [CI, 1.08 to 1.68] for 0.625 mg/d and 1.63 [CI, 1.18 to 2.26] for >/=1.25 mg/d) and those taking estrogen plus progestin (relative risk, 1.45 [CI, 1.10 to 1.92]). Overall, little relation was observed between combination hormone therapy and risk for cardiovascular disease (major coronary heart disease plus stroke) (relative risk, 0.91 [CI, 0.75 to 1.11]). Postmenopausal hormone use appears to decrease risk for major coronary events in women without previous heart disease. Furthermore, 0.3 mg of oral conjugated estrogen daily is associated with a reduction similar to that seen with the standard dose of 0.625 mg. However, estrogen at daily doses of 0.625 mg or greater and in combination with progestin may increase risk for stroke.
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              Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial

              L. Schierbeck, L Rejnmark, C. L. Tofteng … (2012)
              Article 0 comments Cited 124 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: Cochrane Database of Systematic Reviews
                Publisher: Wiley
                ISSN (Electronic): 14651858
                Publication date (Electronic): March 10 2015
                Affiliations
                [1 ]University of Oxford, John Radcliffe Hospital; Department of Cardiovascular Medicine; Oxford UK OX3 9DU
                [2 ]Warwick Medical School, University of Warwick; Division of Health Sciences; Coventry Warwickshire UK CV4 7AL
                [3 ]UK Cochrane Centre; National Institute for Health Research Summertown Pavilion, Middle Way Oxford Oxfordshire UK OX2 7LG
                [4 ]University of Birmingham; Cancer Research UK Clinical Trials Unit (CRCTU), School of Cancer Sciences; Birmingham UK B15 2TT
                [5 ]CIBER Epidemiología y Salud Pública (CIBERESP); Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau); Sant Antoni Maria Claret 171 Edifici Casa de Convalescència Barcelona Catalunya Spain 08041
                [6 ]CIBER Epidemiología y Salud Pública (CIBERESP) - Universitat Autònoma de Barcelona; Iberoamerican Cochrane Centre - Biomedical Research Institute Sant Pau (IIB Sant Pau); Sant Antoni Maria Claret, 167 Pavilion 18 (D-13) Barcelona Catalunya Spain 08025
                [7 ]Hospital Universitario de la Paz, Universidad Autónoma de Madrid; Instituto de Investigacion IdiPAZ, Red Espanola de Investigacion Cardiovascular RD/12/0042/0008; Diego De Leon 62 Planta 9 Madrid Spain 28006
                [8 ]University of Exeter Medical School; NIHR Exeter Clinical Research Facility; Exeter UK
                Article
                DOI: 10.1002/14651858.CD002229.pub4
                PubMed ID: 25754617
                SO-VID: 595c4f05-ce54-401c-84f7-f0f259e71310
                Copyright © © 2015
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