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Experts Weigh in on Hormone Therapy

Risks & Benefits of Postmenopausal Use of Hormones

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VOLUME 2, ISSUE 8
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Coronary Heart Disease


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The table below summarizes the available evidence on the risks and benefits of hormone therapy. Included are all randomized trials and meta-analyses looking at disease incidence or mortality. Inclusion of observational trials was dependent on size: case-control studies with 500 or more cases of the disease and cohort studies with at least 2,000 women are included here.

The year noted is when the study results were published. The name following the title of the study is the last name of the first author on the publication.

E = estrogen; P = progestin

Year

Study

Study Type

Participants

Hormones

Results

Other Notes

1985

Framingham Heart Study, Wilson

Cohort

1,234

E

Increased risk 50%

8 years of follow-up

1987

Lipid Research Clinics Program Follow-up Study, Bush

Cohort

2270

E

Decreased risk 63%

Average follow-up 8.5 years

1993

Rosenberg

Case-control

858 cases, 858 controls

E

No significant difference in risk

 

1996

Nurses' Health Study, Grodstein (A)

Cohort

59,337

E, E + P

E alone decreases risk 40%; E + P decreases risk 39%

Up to 16 years follow-up

1997

Heckbert

Case-control

850 cases, 1,974 controls

E, E + P

8.2 years of hormone use decreases risk 45%

Risk decreased with duration of use; little difference between E and E + P

1997

Hemminki

Meta-analysis of randomized trials

22 studies, 4124 women

E, E+P

No statistically significant effect on risk of cardiovascular events

No distinction between E and E + P

1998

Heart and Estrogen/progestin Replacement Study (HERS), Hulley

Randomized

2,763

E + P

No effect over 4 years; 52% increased risk in the first year

Average follow-up 4.8 years; trial participants had prior history of cardiovascular disease

1998

Sourander

Cohort

7,944

E

Current use decreases risk 79%; no significant difference in former users

8 years of follow-up

1999

Grodstein (B)

Cohort

9,236

E, E + P

Decreases risk 25%

Results similar for E alone and E + P

2000

Varas-Lorenzo

Case-control

1,013 cases, 5,000 controls

E, E + P

Current use of E alone for > 1 year decreases risk 48%; current use of E + P for > 1 year decreases risk 21%

 

2000

Nurses' Health Study, Grodstein

Cohort

70,533

E, E + P

Hormone use decreases risk 39%

Participants had no prior history of cardiovascular disease; no clear difference in risk between E alone and E + P

2001

Nurses' Health Study, Grodstein

Cohort

2,489

E, E + P

Short-term use (<1 year) increases risk 25%; longer-term use decreases risk 62%

Average follow-up 6.9 years; participants had prior history of cardiovascular disease; no difference between E and E + P

2001

Shlipak

Cohort

114,724

E, E + P

Among women with myocardial infarction, hormone use reduced risk of mortality 35%

No distinction between E and E + P; all participants had myocardial infarction

2002

Heart and Estrogen/progestin Replacement Study II (HERS),

Grady

Randomized

2,321

E + P

No overall difference in risk over 6.8 years follow-up

2.7 year extension of HERS with subset of participants from original study; 6.8 years total follow-up; trial participants had prior history of cardiovascular disease

2002

Women's Health Initiative

Randomized

16,608

E + P

Increases risk 29%

5.2 years of follow-up


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