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 in the prevention of atherosclerosis. A randomized, double-blind, placebo-controlled trial.
BACKGROUND Although observational studies suggest that estrogen replacement therapy ( ERT ) reduces cardiovascular morbidity and mortality in postmenopausal women , use of unopposed ERT for prevention of coronary heart disease in healthy postmenopausal women remains untested . OBJECTIVE To determine the effects of unopposed ERT on the progression of sub clinical atherosclerosis in healthy postmenopausal women without preexisting cardiovascular disease . DESIGN R and omized , double-blind , placebo-controlled trial . SETTING University-based clinic . PATIENTS 222 postmenopausal women 45 years of age or older without preexisting cardiovascular disease and with low-density lipoprotein cholesterol levels of 3.37 mmol/L or greater ( > /=130 mg/dL ) . INTERVENTION Unopposed micronized 17beta-estradiol ( 1 mg/d ) or placebo . All women received dietary counseling . Women received lipid-lowering medication if their low-density lipoprotein cholesterol level exceeded 4.15 mmol/L ( 160 mg/dL ) . MEASUREMENTS The rate of change in intima-media thickness of the right distal common carotid artery far wall in computer image processed B-mode ultrasonograms obtained at baseline and every 6 months during the 2-year trial . RESULTS In a multivariable mixed-effects model , among women who had at least one follow-up measurement of carotid intima-media thickness ( n = 199 ) , the average rate of progression of sub clinical atherosclerosis was lower in those taking unopposed estradiol than in those taking placebo ( -0.0017 mm/y vs. 0.0036 mm/y ) ; the placebo-estradiol difference between average progression rates was 0.0053 mm/y ( 95 % CI , 0.0001 to 0.0105 mm/y ) ( P = 0.046 ) . Among women who did not receive lipid-lowering medication ( n = 77 ) , the placebo-estradiol difference between average rates of progression was 0.0147 mm/y ( CI , 0.0055 to 0.0240 ) ( P = 0.002 ) . Average rates of progression did not differ between estradiol and placebo recipients who took lipid-lowering medication ( n = 122 ) ( P > 0.2 ) . CONCLUSIONS Overall , the average rate of progression of sub clinical atherosclerosis was slower in healthy postmenopausal women taking unopposed ERT with 17beta-estradiol than in women taking placebo . Reduction in the progression of sub clinical atherosclerosis was seen in women who did not take lipid-lowering medication but not in those who took these medications
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 .