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Hormone Therapy for Primary Prevention of Cardiovascular Disease in Postmenopausal Women

 

Am Fam Physician. 2018 Oct 1;98(7):online.

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HORMONE THERAPY FOR PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE IN POSTMENOPAUSAL WOMEN

BenefitsHarms

In all women receiving hormone therapy:

No benefit observed

In all women receiving hormone therapy:

1 in 165 women had a stroke

1 in 118 women had a blood clot in the leg or lung

1 in 242 women had a blood clot in the lung

HORMONE THERAPY FOR PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE IN POSTMENOPAUSAL WOMEN

BenefitsHarms

In all women receiving hormone therapy:

No benefit observed

In all women receiving hormone therapy:

1 in 165 women had a stroke

1 in 118 women had a blood clot in the leg or lung

1 in 242 women had a blood clot in the lung

Details for This Review

Study Population: 40,410 postmenopausal women (healthy or with preexisting cardiovascular disease) across 19 randomized controlled trials that examined the use of oral hormone therapy (estrogen with or without progesterone taken for at least six months) compared with placebo

Efficacy End Points: Death from any cause; death caused by heart attack; nonfatal heart attack

Harm End Points: Stroke, thromboembolic event (deep venous thrombosis plus pulmonary embolism) or pulmonary embolism

Narrative: In 2012, the Danish Osteoporosis Prevention Study published a study in the British Medical Journal that compared hormone therapy with placebo and found a decreased risk of heart failure, heart attack, and death from any cause.1 They also found no increased risk of cancer, blood clots, or stroke. Although the Danish cohort studied younger women and used different preparations of hormone therapy, the results were in direct contrast to most of the studies analyzed in a 2005 Cochrane review. This 2005 review found no benefit of hormone therapy in preventing cardiovascular disease, but noted significant increases in the risk of developing stroke and blood clots in a leg or lung.2

The 2015 Cochrane review added six additional studies (compared with the initial review published in 20133), for a total of 19 randomized controlled trials, consisting of 40,410

Author disclosure: No relevant financial affiliations.


Copyright © 2018 MD Aware, LLC (theNNT.com). Used with permission.

This series is coordinated by Dean A. Seehusen, MD, MPH, AFP Assistant Medical Editor, and Daniel Runde, MD, from the NNT Group.

A collection of Medicine by the Numbers published in AFP is available at https://www.aafp.org/afp/mbtn.

References

show all references

1. Schierbeck LL, Rejnmark L, Tofteng CL, et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ. 2012;345:e6409....

2. Gabriel SR, Carmona L, Roque M, Sanchez GL, Bonfill X. Hormone replacement therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev. 2005;(2):CD002229.

3. Main C, Knight B, Moxham T, et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev. 2013;(4):CD002229.

4. Boardman HM, Hartley L, Eisinga A, et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev. 2015;(3):CD002229.

 

 

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