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 .
The comparative effect on bone density, endometrium, and lipids of continuous hormones as replacement therapy (CHART study). A randomized controlled trial.
OBJECTIVE To compare the effect of continuous norethindrone acetate (NA)-ethinyl estradiol ( EE2 ) combinations with matching unopposed EE2 or placebo . DESIGN A 2-year , double-blind , placebo-controlled , parallel-group clinical trial . SETTING Out patients at 65 centers . PATIENTS Asymptomatic or mildly symptomatic women aged 40 years or older who had undergone the onset of spontaneous menopause within the last 5 years and who had an intact uterus . INTERVENTIONS Patients were equally r and omized to placebo or 1 of 8 treatment groups : 0.2 mg of NA and 1 microg of EE2 ; 0.5 mg of NA and 2.5 microg of EE2 ; 1 mg of NA and 5 microg of EE2 ; 1 mg of NA and 10 microg of EE2 ; 1 microg of EE2 ; 2.5 microg of EE2 ; 5 microg of EE2 ; or 10 microg of EE2 . PRIMARY OUTCOME MEASURES Bone mineral density ( BMD ) measured by quantitative computed tomography , serum lipids , and endometrial effects as assessed by rate of hyperplasia and proliferative status . RESULTS Twelve hundred sixty-five patients entered the study . Bone mineral density increased significantly from baseline ( P<.001 ) in the 1 mg NA-5 microg EE2 and the 1 mg NA-10 microg EE2 treatment groups at each annual assessment . Among the unopposed EE2 groups , only the 10-microg group had increased BMD above baseline , but also was accompanied by an unacceptably high rate of endometrial hyperplasia . The NA-EE2 treatment groups had a significant linear dose-response trend for increasing BMD . Increased endometrial proliferation and hyperplasia occurred with increasing unopposed estrogen doses . The combination of NA and EE2 effectively protected the endometrium against hyperplasia . The percentage of change in the ratio of high-density lipoprotein cholesterol to low-density lipoprotein cholesterol was positive for all treatment groups . The increase in triglyceride levels associated with EE2 was attenuated with NA-EE2 treatment . CONCLUSIONS Daily treatment with NA-EE2 was well tolerated and protected the endometrium from EE2-induced proliferation and hyperplasia . The NA-EE2 treatments produced a dose-related significant increase in BMD that was not present with unopposed EE2 treatment . The overall effect of NA-EE2 treatments on lipid measures was favorable
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 .