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HT may reduce mortality risk in statin-treated postmenopausal women
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In women treated with statins, hormone therapy appears to decrease the risk for death from any cause, according to research published in Menopause.
Although lifestyle and disease severity could influence results, researchers found that HT had no detrimental effect in a population of Swedish women also taking the cholesterol-lowering drugs.
“In this nationwide cohort study including women treated with statins, hormone therapy was associated with a reduced risk of all-cause mortality, and we found no association with occurrence of cardiovascular events,” the researchers wrote.
Using data from national Swedish health registers, Ingegärd Anveden Berglind, MD, PhD, of the Karolinska Institute in Stockholm, and colleagues identified 40,958 statin users aged 40 to 74 years, of whom 70% used the drugs as primary prevention.
The researchers categorized the women into groups of HT users (n = 2,862; 7%) or nonusers (n = 38,096) and followed them for an average of 4 years. Data on dispensed drugs, comorbidity, CV outcomes and all-cause mortality were gathered from the registers.
Among users, five CV deaths occurred per 10,000 person-years compared with 18 for nonusers (HR = 0.38; 95% CI, 0.12-1.19). The rates of death from any cause per 10,000 person-years were 33 for users and 87 for nonusers (HR = 0.53; 95% CI, 0.34-0.81).
No associations were observed for CV events. Similar patterns were found whether statins were used for primary or secondary prevention.
“In light of the current prevention strategies for cardiovascular diseases, such as statin use and lifestyle interventions, it should be valuable to reflect on the restricted use of hormone therapy in women treated with statins,” the researchers wrote.
The potential beneficial effect on CV deaths counters the findings from the Women’s Health Initiative and the Heart and Estrogen/progestin Replacement Study (HERS).
The researchers reason this could be related to type of estrogen; the women in WHI and HERS received conjugated estrogens, whereas the Swedish women used 17-beta estradiol.
Statins also could diminish the risk for coronary heart events that occur early in HT, when estrogen could cause instability in arterial plaque, leading to blood clots, myocardial infarction and strokes, according to the researchers.
In an accompanying editorial, Howard N. Hodis, MD, and Wendy J. Mack, PhD, both of the Keck School of Medicine, University of Southern California, noted that cardiac events rose after starting HT before decreasing in the HERS study, but they commended the researchers’ work.
“Berglind et al are to be commended for their important and timely contribution to hormone therapy and cardiovascular disease outcomes and mortality in statin-treated women,” they wrote. – by Allegra Tiver
Disclosures: The researchers report no relevant financial disclosures.
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