Researchers found no suggestion of a decreased risk for coronary heart
disease within the first two years of estrogen plus progestin use, including in
women who initiated hormone therapy within 10 years after menopause, according
to new findings from the Women’s Health Initiative.
For the current analysis, researchers assessed the effect of estrogen
plus progestin therapy on CHD risk distinguished by years since menopause. The
double blind, placebo-controlled, multicenter, primary prevention WHI trial
included 16,608 women randomly assigned to once-daily conjugated equine
estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg (n=8,506) or placebo
(n=8,102). The analysis was adjusted for about the 40% of women who stopped use
of at least 80% of assigned treatment by year six.
The researchers identified 188 cases of CHD in women assigned to HT,
including 80 cases during the first two years of follow-up, compared with 147
cases in women assigned to placebo.
When compared with women assigned placebo, the estimated average HR of
CHD during the first two years of HT use was 2.36 (95% CI, 1.55-3.62) and 1.69
(95% CI, 0.98-2.89) during the first eight years of use.
Among women who were within 10 years of menopause at baseline, the
estimated average HR was 1.29 (95% CI, 0.52-3.18) during the first two years of
follow-up and 0.64 (95% CI, 0.21-1.99) during the first eight years of
follow-up.
“A possible cardioprotective effect of estrogen plus progestin
among women within 10 years of menopause was apparent only after approximately
six years of use,” the researchers wrote. “Based on these findings,
an expected reduction of CHD risk should not be a consideration for initiation
or continuation of HT in most newly menopausal women because women in this
group generally use this therapy for a short period.” - by Jennifer
Southall
Toh S. Ann Intern Med. 2010;152:211-217.
The article by Toh and colleagues adds further to our knowledge
regarding conjugated estrogen plus progesterone use during the postmenopausal
period. It is clear that regardless of the timing, these hormones given either
early or late in the menopause transition have an increased risk of coronary
artery disease associated with their use. Thus, unless there are compelling
indications for a specific condition, HT is not advised for CV risk
reduction.
- George Bakris, MD
Endocrine Today Editorial
Board member
This recent analysis of the WHI estrogen plus progestin randomized trial found no evidence that combined HT use reduces risk of CHD during the first six years of use, even among women within 10 years of menopause (who have a lower baseline risk of CHD than older postmenopausal women). These findings support current recommendations that, while HT remains an effective treatment for menopausal vasomotor symptoms, it should not be used for CHD risk reduction. Though these data did suggest a possible cardioprotective effect after approximately six years of HT use, most women use HT for a shorter period of time for relief of menopausal symptoms. When weighing the risks and benefits of postmenopausal combined HT, these data support the notion that CHD risk reduction should not be considered one of the benefits for most women, even recently postmenopausal women.
- Emily Szmuilowicz, MD
Instructor of clinical medicine, Northwestern University,
Feinberg School of Medicine
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