We found high quality evidence that hormone therapy in both primary and secondary prevention conferred no protective effects for all-cause mortality , cardiovascular death , non-fatal myocardial infa rct ion , angina , or revascularisation .
There was no strong evidence of effect on risk of stroke in this group .
Our review findings provide strong evidence that treatment with hormone therapy in post-menopausal women overall , for either primary or secondary prevention of cardiovascular disease events has little if any benefit and causes an increase in the risk of stroke and venous thromboembolic events
BACKGROUND Evidence from systematic review s of observational studies suggests that hormone therapy may have beneficial effects in reducing the incidence of cardiovascular disease events in post-menopausal women , however the results of r and omised controlled trials ( RCTs ) have had mixed results .
This is an up date d version of a Cochrane review published in 2013 .
OBJECTIVES To assess the effects of hormone therapy for the prevention of cardiovascular disease in post-menopausal women , and whether there are differential effects between use in primary or secondary prevention .
Secondary aims were to undertake exploratory analyses to ( i ) assess the impact of time since menopause that treatment was commenced ( ≥ 10 years versus < 10 years ) , and where these data were not available , use age of trial participants at baseline as a proxy ( ≥ 60 years of age versus < 60 years of age ) ; and ( ii ) assess the effects of length of time on treatment .
Pulse Pressure and Coronary Atherosclerosis Progression in Postmenopausal Women
Pulse pressure , an index of large artery stiffness , has been associated with coronary events . However , mechanisms for this association remain unclear . In this study , we examined the relationship between pulse pressure and the progression of coronary atherosclerosis and the effects of hormone replacement therapy ( HRT ) on pulse pressure in postmenopausal women with angiographically confirmed coronary disease followed for 3.2 years in the Estrogen Replacement in Atherosclerosis ( ERA ) trial . In the ERA trial , 309 postmenopausal women ( mean age 66±7 years ) with coronary disease were r and omized to estrogen , estrogen plus progestin , or placebo , and followed for 3.2 years . Ten st and ardized epicardial segments were measured for minimal diameter values at baseline and follow-up using quantitative coronary angiography . For this study , mixed-model analysis of covariance was used to : ( 1 ) test the association between pulse pressure and change in mean minimum diameter ( MMD ) adjusted for baseline MMD and ( 2 ) the effect of HRT on follow-up pulse pressure . After adjustment for potential confounders , there was a significant grade d increase in progression of coronary stenosis with increasing quartiles of baseline pulse pressure ( P test for trend=0.0001 ) . The progression rate in women with the highest quartile of baseline pulse pressure was 5-fold higher than in women in the lowest quartile ( P<0.01 ) . In postmenopausal women with coronary disease , increased levels of baseline pulse pressure are associated with subsequent progression of coronary atherosclerosis in postmenopausal women . HRT had no detectable effect on pulse pressure
We found high quality evidence that hormone therapy in both primary and secondary prevention conferred no protective effects for all-cause mortality , cardiovascular death , non-fatal myocardial infa rct ion , angina , or revascularisation .
There was no strong evidence of effect on risk of stroke in this group .
Our review findings provide strong evidence that treatment with hormone therapy in post-menopausal women overall , for either primary or secondary prevention of cardiovascular disease events has little if any benefit and causes an increase in the risk of stroke and venous thromboembolic events
BACKGROUND Evidence from systematic review s of observational studies suggests that hormone therapy may have beneficial effects in reducing the incidence of cardiovascular disease events in post-menopausal women , however the results of r and omised controlled trials ( RCTs ) have had mixed results .
This is an up date d version of a Cochrane review published in 2013 .
OBJECTIVES To assess the effects of hormone therapy for the prevention of cardiovascular disease in post-menopausal women , and whether there are differential effects between use in primary or secondary prevention .
Secondary aims were to undertake exploratory analyses to ( i ) assess the impact of time since menopause that treatment was commenced ( ≥ 10 years versus < 10 years ) , and where these data were not available , use age of trial participants at baseline as a proxy ( ≥ 60 years of age versus < 60 years of age ) ; and ( ii ) assess the effects of length of time on treatment .