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 .
Striking Increases in Carotid Artery Wall Thickness in Healthy Subjects
Background : Atherosclerosis has long been thought to develop over time in a linear manner from gradual wall thickening to advanced thick lesions . However , evidence has emerged indicating a phasic rather than linear progression with time . A major reason for this non-linear pattern appears to be the occurrence of hemorrhages in the arterial wall , although data on this issue are still scarce . We studied the occurrence of temporarily impressive thickenings of the carotid arterial wall in a cohort of healthy postmenopausal women who were followed up for 3 years with regular carotid ultrasound examinations .  Methods : The women were the European participants of a r and omized placebo-controlled trial into the effect of hormone replacement therapy on progression of carotid intima-media thickness ( CIMT ) .  For a period of 3 years , the women underwent a st and ardized carotid ultrasound protocol every 6 months . Common , bifurcation and internal carotid segments were scanned on both sides , stored on videotape , and the near and far wall CIMT was measured on defined angles and segments , also in areas of plaque . Adverse events were routinely recorded . At the completion of the study , all segment-specific measurements were evaluated for outliers . Images were retrieved from videotape and evaluated whether the outlier result ed from a real morphological change or ‘ measurement error ’ . Results : The 509 healthy postmenopausal women , free from previous symptomatic cardiovascular disease , underwent 3,812 carotid ultrasound scans during the study , and 44,924 carotid segments were evaluated . In 203 segments of 188 participants outliers were observed . True morphological changes were found in 12 participants , equivalent to a 3-year risk of 2.4 % . These changes did not give rise to clinical symptoms . In the 6 women of whom we had follow-up measurements , the changes were reversed within 6–12 months . Conclusion : We observed acute increases in CIMT among 2.4 % of healthy postmenopausal European women followed for 3 years . When assuming these were the result of vessel wall hemorrhages , our findings add to the body of evidence suggesting that vessel wall hemorrhages contribute to atherosclerosis development and also appear to occur clinical ly silent
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 .