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 .
Estrogen plus progestin and risk of venous thrombosis.
CONTEXT Postmenopausal hormone therapy increases the risk of venous thrombosis .  It is not known whether other factors influencing thrombosis add to this risk . OBJECTIVE To report final data on incidence of  venous thrombosis in the Women 's Health Initiative Estrogen Plus Progestin clinical trial and the association of hormone therapy with venous thrombosis in the setting of other thrombosis risk factors . DESIGN , SETTING , AND PARTICIPANTS Double-blind r and omized controlled trial of 16,608 postmenopausal women between the ages of 50 and 79 years , who were enrolled in 1993 through 1998 at 40 US clinical centers with 5.6 years of follow up ; and a nested case-control study . Baseline gene variants related to thrombosis risk were measured in the first 147 women who developed thrombosis and in 513 controls . INTERVENTION R and om assignment to 0.625 mg/d of conjugated equine estrogen plus 2.5 mg/d of medroxyprogesterone acetate , or placebo . MAIN OUTCOME MEASURES Central ly vali date d deep vein thrombosis and pulmonary embolus . RESULTS Venous thrombosis occurred in 167 women taking  estrogen plus progestin  ( 3.5 per 1000 person-years ) and in 76 taking placebo ( 1.7 per 1000 person-years ) ; hazard ratio ( HR ) , 2.06 ( 95 % confidence interval [ CI ] , 1.57 - 2.70 ) . Compared with women between the ages of 50 and 59 years who were taking placebo , the risk associated with hormone therapy was higher with age : HR of 4.28 ( 95 % CI , 2.38 - 7.72 ) for women aged 60 to 69 years and 7.46 ( 95 % CI , 4.32 - 14.38 ) for women aged 70 to 79 years . Compared with women who were of normal weight and taking placebo , the risk associated with taking estrogen plus progestin  was increased among overweight and obese women : HR of 3.80 ( 95 % CI , 2.08 - 6.94 ) and 5.61 ( 95 % CI , 3.12 - 10.11 ) , respectively . Factor V Leiden enhanced the hormone-associated risk of thrombosis with a 6.69-fold increased risk compared with women in the placebo group without the mutation ( 95 % CI , 3.09 - 14.49 ) . Other genetic variants ( prothrombin 20210A , methylenetetrahydrofolate reductase C677 T , factor XIII Val34Leu , PAI-1 4G/5 G , and factor V HR2 ) did not modify the association of hormone therapy with venous thrombosis . CONCLUSIONS Estrogen plus progestin was associated with doubling the risk of venous thrombosis .  Estrogen plus progestin therapy increased the risks associated with age , overweight or obesity , and factor V Leiden
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 .