For the past 60 years postmenopausal hormone replacement therapy (HT) has been prescribed to alleviate menopausal symptoms. This policy was first challenged in 1998 when a combination of conjugated equine estrogens (Premarin) and medroxyprogesterone acetate (progesterone) proved to be ineffective and potentially harmful for the prevention of coronary heart disease. In 2002, the Women’s Health Initiative study showed that conjugated equine estrogens alone, or in combination with medroxyprogesterone acetate, failed in the primary prevention of coronary heart disease. The Women’s Health Initiative study modified the guidelines for the optimal use of HT and led to a rapid decrease in the use of HRT worldwide. A new study examined whether the decreased usage of HRT resulted in decreased cardiovascular disease deaths in postmenopausal women. They study was published in the November edition of the journal Obstetrics & Gynecology by Finnish and Swedish researchers.
The objective of the study was to examine whether coronary heart disease mortality in Finnish HRT users differed before and after 2002 when the Women’s Health Initiative study was published. The risks of coronary heart disease death in HRT users in relation to the age-matched background population were compared between the pre– (1995–2001) and post– (2002–2009) Women’s Health Initiative eras. The investigators accessed a nationwide register on HRT (estrogen with or without progesterone) use and linked it to causes of death in 290,272 women aged 40 years or older.
The investigators found that exposure to HRT for one year or less was accompanied by a 29% reduction and an exposure of one-to-eight years with a 43% reduction of the risk of coronary heart disease death in the pre-Women’s Health Initiative era. In the post-Women’s Health Initiative era, HRT use of one year or less was associated with an 18% reduction and an exposure of one-to-eight years with a 54% reduction in coronary heart disease mortality. Discontinuation of HRT was associated with an increased risk of cardiac death of 42% in the pre–Women’s Health Initiative era and 31% in the post–Women’s Health Initiative era during the first post-treatment year. This risk disappeared vanished in further follow-up during both eras.
The authors concluded that changes in HRT use after the Women’s Health Initiative failed to affect coronary heart disease mortality of HT users in their nationwide study.
Take home message:
The healthcare systems in Scandinavia provide comprehensive health information on their residents; thus, increasing the validity of their results. This study suggests that HRT does not alter the risk of death from cardiovascular disease in postmenopausal women. Other factors do significantly affect the risk of cardiovascular disease. These include overweight/obesity, smoking, lack of exercise, and poor diet.