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 .
Noninvasive Assessment of Coronary Microcirculatory Function in Postmenopausal Women and Effects of Short-Term and Long-Term Estrogen Administration
Background —Estrogen improves endothelial function in the coronary conduit vessels of animals ; however , its effects on the coronary microcirculation have not been studied completely in humans . Methods and Results —We measured myocardial blood flow ( MBF ) with a PET scan at rest , during cold pressor testing ( CPT ) , and during dipyridamole hyperemia in 54 postmenopausal women without coronary artery disease . Of these , 23 were not and 31 women were taking long-term hormone replacement therapy ( HRT ) using estrogen either alone or with a progestogen . Each group was subdivided by coronary risk factors ( RFs ) . Twelve young healthy women served as controls . In women not taking HRT , MBF measurements were repeated after 25 mg of conjugated equine estrogens IV . Neither short estrogen nor long-term HRT affected MBF at rest in women with and without RFs . Dipyridamole MBF was attenuated only in the women with RF who were not taking HRT . Short-term estrogen and long-term HRT did not reverse the abnormal response . MBF responses to CPT were abnormal in women not taking HRT , regardless of RFs ( 20±15 % versus 32±21 % ) and remained unchanged after short-term estrogen administration . Long-term HRT normalized the response to CPT only in women without RF ( 53±22 % versus 59±36 % in the young women ; NS ) . MBFs were similar for women on estrogen alone or estrogen plus a progestogen , regardless of presence or absence of RFs . Conclusion —Menopause is associated with abnormal CPT ( an indirect measure of endothelial function ) , which can be reversed by long-term HRT only when RFs are absent . Progestogens do not antagonize this effect . Long-term HRT may therefore be useful in the primary prevention of coronary artery disease in women without RFs
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 .