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WHI: Risk for CHD, stroke may depend on HT formulation
Varying formulations, dosages and delivery of hormone therapies have been associated with similar rates of cardiovascular events and all-cause mortality, according to new observational data from the Women’s Health Initiative. Oral estradiol in particular may be linked to a lower risk for stroke compared with other formulations, research suggests.
“If confirmed by future randomized trials, these findings may be significant because, for the past decade, many women who experienced severe menopause symptoms opted not to use hormone therapy because of the reported increased risk of stroke and heart attacks,” Chrisandra Shufelt, MD, director of the Women’s Hormone and Menopause Program at the Barbra Streisand Women’s Heart Center in the Cedars-Sinai Heart Institute, said in a press release.
Chrisandra Shufelt
Oral estradiol was linked to a lower risk for stroke compared with oral conjugated equine estrogens (CEE; HR=0.64; 95% CI, 0.4-1.02). However, there was a lower risk for coronary heart disease compared with oral CEE (HR=0.63; 95% CI, 0.37-1.06), and oral low-dose HT was linked to lower risk for CHD, according to data.
Shufelt and colleagues’ analysis included 93,676 postmenopausal women aged 50 to 79 years from the Women’s Health Initiative Observational Study (WHI-OS).
Overall, the transdermal route did not significantly lower risk for stroke and CVD compared with CEE, researchers wrote. The risk for CVD mortality and all-cause mortality were similar to those for CEE.
These results could have clinical implications for postmenopausal women who currently require HT for vasomotor symptoms, according to researchers. Further research is warranted to confirm these findings.
Disclosure: Shufelt reports no relevant financial disclosures. Other researchers report various ties with Abbott Vascular, Amylin, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli Lilly, GI Dynamics, Gilead, GlaxoSmithKline, N-Gene, Noven, Novo Nordisk, PhaseBio, Roche, Sanofi-Aventis and Teva.
Perspective
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I found the findings by Shufelt and colleagues interesting. There is still so much interest in HRT; gleaning what we can from WHI is important. Health care professionals have questioned if the type of HRT matter or the dose of estrogen matters in terms of CVD risk. However, the findings here did not hold significant meaning to me, and there was no difference seen in WHI in terms of CHD or stroke risk.
It is important to note that this was observational data. In addition, there were only a small number of women on transdermal or low-dose estrogen, likely influencing the insignificant findings. It is possible that if we had more women using either in the cohort, the results could be significant. However, it could go in either direction.
I think we have learned our lessons from observational data, taking from it what we can. Ultimately, a randomized trial will provide more answers. After all, the WHI-CT study disproved what observational data was suggesting. In my opinion, we need more data and a randomized study to tell us if either form of HRT is safer for women and their CHD or stroke risk.