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 .
Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin.
CONTEXT The Women 's Health Initiative ( WHI ) trial of estrogen plus progestin vs placebo was stopped early , after a mean 5.6 years of follow-up , because the overall health risks of hormone therapy exceeded its benefits . OBJECTIVE To report health outcomes at 3 years ( mean 2.4 years of follow-up ) after the intervention was stopped . DESIGN , SETTING , AND PARTICIPANTS The intervention phase was a double-blind , placebo-controlled , r and omized trial of conjugated equine estrogens ( CEE ) 0.625 mg daily plus medroxyprogesterone acetate ( MPA ) 2.5 mg daily , in 16,608 women aged 50 through 79 years , recruited by 40 centers from 1993 to 1998 . The postintervention phase commenced July 8 , 2002 , and included 15 730 women . MAIN OUTCOME MEASURES Semi-annual monitoring and outcomes ascertainment continued per trial protocol . The primary end points were coronary heart disease and invasive breast cancer . A global index summarizing the balance of risks and benefits included the 2 primary end points plus stroke , pulmonary embolism , endometrial cancer , colorectal cancer , hip fracture , and death due to other causes . RESULTS The risk of cardiovascular events after the intervention was comparable by initial r and omized assignments , 1.97 % ( annualized rate ) in the CEE plus MPA ( 343 events ) and 1.91 % in the placebo group ( 323 events ) . A greater risk of malignancies occurred in the CEE plus MPA than in the placebo group ( 1.56 % [ n = 281 ] vs 1.26 % [ n = 218 ] ; hazard ratio [ HR ] , 1.24 ; 95 % confidence interval [ CI ] , 1.04 - 1.48 ) . More breast cancers were diagnosed in women who had been r and omly assigned to receive CEE plus MPA vs placebo ( 0.42 % [ n = 79 ] vs 0.33 % [ n = 60 ] ; HR , 1.27 ; 95 % CI , 0.91 - 1.78 ) with a modest trend toward a lower HR during the follow-up after the intervention . All-cause mortality was somewhat higher in the CEE plus MPA than in the placebo group ( 1.20 % [ n = 233 ] vs 1.06 % [ n = 196 ] ; HR , 1.15 ; 95 % CI , 0.95 - 1.39 ) . The global index of risks and benefits was unchanged from r and omization through March 31 , 2005 ( HR , 1.12 ; 95 % CI , 1.03 - 1.21 ) , indicating that the risks of CEE plus MPA exceed the benefits for chronic disease prevention . CONCLUSIONS The increased cardiovascular risks in the women assigned to CEE plus MPA during the intervention period were not observed after the intervention . A greater risk of fatal and nonfatal malignancies occurred after the intervention in the CEE plus MPA group and the global risk index was 12 % higher in women r and omly assigned to receive CEE plus MPA compared with placebo . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00000611
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 .