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Hormone therapy offers no CV protection for postmenopausal women, may increase stroke risk
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Hormone replacement therapy does not protect postmenopausal women against cardiovascular disease and may increase their risk for stroke and venous thromboembolic events, according to research published in the Cochrane Library.
Results from a review of randomized controlled trials comparing orally administered estrogen therapy, with or without progestogen, with placebo or no treatment, over periods ranging from 7 months to longer than 10 years, in more than 40,410 women showed risks and benefits vary by what age the women were at treatment initiation.
“The evidence we have provides some support for the so-called ‘Timing Hypothesis,’ but we should bear in mind the size of this effect,” Henry M. P. Boardman, a clinical research fellow at University of Oxford, John Radcliffe Hospital, said in a news release. “When we looked at the results according to the age of women, or by how long since their menopause that they started treatment, we found that if 1,000 women under 60 years old started hormone therapy we would expect six fewer deaths, eight fewer cases of heart disease and five extra blood clots over about seven years, compared to a 1,000 similar women who did not start hormone therapy.”
Henry M. P. Boardman
Boardman and colleagues from other institutions identified six new trials through a search of The Cochrane Library, MEDLINE, Embase and LILACS databases, along with research and trials registers. They reviewed 19 studies altogether, all high quality with low risk of bias, but findings mainly came from the three largest.
The investigators primarily sought the effects of hormone therapy in preventing cardiovascular disease and potential differential effects between treatments for primary or secondary prevention.
The researchers performed secondary exploratory analyses to assess the impact of time since treatment initiation (≥ 10 years vs. < 10 years) and baseline treatment use age (≥ 60 years old vs. < 60 years old), and also effects of length of time on treatment.
Risk ratios with 95% CIs were calculated for each outcome. The results were combined using random effects meta-analyses to evaluate for primary or secondary prevention and treatment initiation.
In both primary and secondary prevention, high quality evidence showed hormone therapy offered no protective effects against all-cause mortality, cardiovascular death, nonfatal myocardial infarction, angina or revascularization.
An increased risk of stroke was observed in women receiving treatment for combined primary and secondary prevention (RR = 1.24; 95% CI, 1.10-1.41). Increased risk was also seen for venous thromboembolic events (RR = 1.92; 95% CI, 1.36-2.69) and pulmonary emboli (RR = 1.81; 95% CI 1.32-2.48) compared with placebo.
Woman who began hormone therapy within 10 years of menopause had lower mortality (RR = 0.70; 95% CI, 0.52-0.95) and coronary heart disease, based on composite of death from cardiovascular causes and nonfatal myocardial infarction (RR = 0.52; 95% CI, 0.29-0.96); however, this group was still at increased risk for venous thromboembolism (RR = 1.74; 95% CI 1.11-2.73) compared with placebo or no treatment.
“The findings of this Cochrane review need to be carefully considered,” Boardman said. “This is a complicated health issue, where the same treatment offers benefits in some women, but harms in others.” – by Allegra Tiver
Disclosure: Endocrine Today could not confirm disclosures at time of publishing.
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