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Vol. 104, No. 3, 2005
Issue release date: September 2005

Hormone Replacement Therapy and Secondary Cardiovascular Prevention: A Meta-Analysis of Randomized Trials

Cho L. · Mukherjee D.
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Abstract

Background: Coronary artery disease is the leading cause of death in women. Several randomized clinical trials of hormone replacement therapy (HRT) in women with and without coronary artery disease have found no benefit of HRT in decreasing cardiovascular events. The purpose of this study was to assess the benefits and risks of HRT for prevention of cardiovascular events by conducting a meta-analysis of all randomized trials of HRT, and estimate cardiovascular event rates. Methods and Results: All relevant randomized, clinical trials were identified in MEDLINE (1966–2001), HealthSTAR (1975–2001), and Cochrane Library databases. The search terms were hormone replacement or HRT[, ]estrogen[, ]progesterone[, ]women and heart disease. We used all published data of randomized, clinical trials of HRT if they reported cardiovascular endpoints. Meta-analysis of the randomized, clinical trials involving 21,066 patients revealed that HRT did not reduce mortality compared with control group (1.9 vs. 1.9%, odds ratio 1.05, 95% CI 0.86–1.30, p = 0.58) or significantly reduce risk of myocardial infarction (3.7 vs. 3.7%, odds ratio 1.04, 95% CI 0.90–1.21, p = 0.58) or revascularization (6.4 vs. 6.8%, odds ratio 0.95, 95% CI 0.85–1.08, p = 0.50). The rate of acute coronary syndrome rate was 9.1% in the HRT group vs. 9.3% with odds ratio 1.00, 95% CI 0.90–1.12, p = 0.98. Conclusion: HRT use is not associated with reduced death, myocardial infarction or revascularization rate. This suggests that HRT is not an effective secondary cardiovascular preventive measure.



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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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