Hormone Replacement Therapy and Secondary Cardiovascular Prevention: A Meta-Analysis of Randomized TrialsCho L.a · Mukherjee D.b
aLoyola University Medical Center Maywood, Maywood, Ill., and bUniversity of Kentucky, Lexington, Ky., USA
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Article / Publication Details
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.
© 2005 S. Karger AG, Basel
- Grodstein F, Stampfer M: The epidemiology of coronary heart disease and estrogen replacement in postmenopausal women. Prog Cardiovasc Dis 1995;38:199–210.
- Grady D, Rubin SM, Petitti DB, Fox CS, Black D, Ettinger B, Ernster VL, Cummings SR: Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med 1992;117:1016–1037.
- Manson JE, Hsia J, Johnson KC, Rossouw JE, Assaf AR, Lasser NL, Trevisan M, Black HR, Heckbert SR, Detrano R, Strickland OL, Wong ND, Crouse JR, Stein E, Cushman M: Women’s Health Initiative. I. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med 2003;349:523–534.
- Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, Vittinghoff E: Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA 1998;280:605–613.
- Cherry N, Gilmour K, Hannaford P, Heagerty A, Khan MA, Kitchener H, McNamee R, Elstein M, Kay C, Seif M, Buckley H, team E: Oestrogen therapy for prevention of reinfarction in postmenopausal women: a randomised placebo-controlled trial. Lancet 2002;360:2001–2008.
- Clarke SC, Kelleher J, Lloyd-Jones H, Slack M, Schofiel PM: A study of hormone replacement therapy in postmenopausal women with ischaemic heart disease: the Papworth HRT atherosclerosis study. BJOG 2002;109:1056–1062.
- De Kleijn MJ, Wilmink HW, Bots ML, Bak AA, van der Schouw YT, Planellas J, Engelen S, Banga JD, Grobbee DE: Hormone replacement therapy and endothelial function. Results of a randomized controlled trial in healthy postmenopausal women. Atherosclerosis 2001;159:357–365.
- Herrington DM, Reboussin DM, Brosnihan KB, Sharp PC, Shumaker SA, Snyder TE, Furberg CD, Kowalchuk GJ, Stuckey TD, Rogers WJ, Givens DH, Waters D: Effects of estrogen replacement on the progression of coronary-artery atherosclerosis. N Engl J Med 2000;343:522–529.
- Hodis HN, Mack WJ, Lobo RA, Shoupe D, Sevanian A, Mahrer PR, Selzer RH, Liu CR, Liu CH, Azen SP: Estrogen in the Prevention of Atherosclerosis Trial Research G. Estrogen in the prevention of atherosclerosis. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2001;135:939–953.
- Hodis HN, Mack WJ, Azen SP, Lobo RA, Shoupe D, Mahrer PR, Faxon DP, Cashin-Hemphill L, Sanmarco ME, French WJ, Shook TL, Gaarder TD, Mehra AO, Rabbani R, Sevanian A, Shil AB, Torres M, Vogelbach KH, Selzer RH: Women’s Estrogen-Progestin Lipid-Lowering Hormone Atherosclerosis Regression Trial Research G. Hormone therapy and the progression of coronary-artery atherosclerosis in postmenopausal women. N Engl J Med 2003;349:535–545.
- Angerer P, Stork S, Kothny W, Schmitt P, von Schacky C: Effect of oral postmenopausal hormone replacement on progression of atherosclerosis: a randomized, controlled trial. Arterioscler Thromb Vasc Biol 2001;21:262–268.
- Waters DD, Alderman EL, Hsia J, Howard BV, Cobb FR, Rogers WJ, Ouyang P, Thompson P, Tardif JC, Higginson L, Bittner V, Steffes M, Gordon DJ, Proschan M, Younes N, Verter JI: Effects of hormone replacement therapy and antioxidant vitamin supplements on coronary atherosclerosis in postmenopausal women: a randomized controlled trial. JAMA 2002;288:2432–2440.
- Grady D, Herrington D, Bittner V, Blumenthal R, Davidson M, Hlatky M, Hsia J, Hulley S, Herd A, Khan S, Newby LK, Waters D, Vittinghoff E, Wenger N, Group HR: Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA 2002;288:49–57.
- Barrett-Connor E, Grady D, Sashegyi A, Anderson PW, Cox DA, Hoszowski K, Rautaharju P, Harper KD; MORE Investigators (Multiple Outcomes of Raloxifene Evaluation): Raloxifene and cardiovascular events in osteoporotic postmenopausal women: four-year results from the MORE randomized trial. JAMA 2002;287:847–857.
- Guetta V, Cannon RO 3rd: Cardiovascular effects of estrogen and lipid-lowering therapies in postmenopausal women. Circulation 1996;93:1928–1937.
- Zhu X, Bonet B, Gillenwater H, Knopp RH: Opposing effects of estrogen and progestins on LDL oxidation and vascular wall cytotoxicity: implications for atherogenesis. Proc Soc Exp Biol Med 1999;222:214–221.
- Pratico D, FitzGerald GA: Testosterone and thromboxane. Of muscles, mice, and men. Circulation 1995;91:2694–2698.
- Herrington DM, Braden GA, Williams JK, Morgan TM: Endothelial-dependent coronary vasomotor responsiveness in postmenopausal women with and without estrogen replacement therapy. Am J Cardiol 1994;73:951–952.
- Grodstein F, Stampfer MJ, Manson JE, Colditz GA, Willett WC, Rosner B, Speizer FE, Hennekens CH: Postmenopausal estrogen and progestin use and the risk of cardiovascular disease. N Engl J Med 1996;335:453–461. Erratum in N Engl J Med 1996;335:1406.
- Grodstein F, Stampfer MJ, Colditz GA, Willett WC, Manson JE, Joffe M, Rosner B, Fuchs C, Hankinson SE, Hunter DJ, Hennekens CH, Speizer FE: Postmenopausal hormone therapy and mortality. N Engl J Med 1997;336:1769–1775.
Mosca L, Grundy SM, Judelson D, King K, Limacher M, Oparil S, Pasternak R, Pearson TA, Redberg RF, Smith SC Jr, Winston M, Zinberg S: Guide to Preventive Cardiology for Women. AHA/ACC Scientific Statement Consensus Panel Statement. Circulation 1999;99:2480–2484.
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