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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Postmenopausal Hormone Use and Primary Prevention of Heart Disease and Stroke in Healthy Women
19 December 2000 | Volume 133 Issue 12 | Page S60
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician.
The summary below is from the full report titled "A Prospective, Observational Study of Postmenopausal Hormone Therapy and Primary Prevention of Cardiovascular Disease." It is in the 19 December 2000 issue of Annals of Internal Medicine (volume 133, pages 933-941). The authors are F Grodstein, JE Manson, GA Colditz, WC Willett, FE Speizer, and MJ Stampfer.
What is the problem and what is known about it so far?
Primary prevention means preventing a disease in persons with no history of the disease; secondary prevention means preventing recurrence or progression of the disease in persons who already have it. Many preliminary studies have suggested that treatment with hormones protects women from heart disease, but a recent large trial of hormone replacement therapy in women with heart disease (secondary prevention) indicated that the effects of hormone therapy on the heart may be somewhat complicated; it looked like more heart attacks and strokes occurred with short-term use of hormones, but that fewer such events occurred with longer-term hormone use. Information from similar trials about primary prevention is not available.
Why did the researchers do this particular study?
To get further information on whether postmenopausal women without previous heart attacks and strokes who take hormones have fewer cardiovascular events than women who do not.
Who was studied?
The researchers studied 70,533 postmenopausal female nurses who had no known history of previous cardiovascular disease.
How was the study done?
The women were surveyed in 1976 to find out whether they had ever used postmenopausal hormones. The survey also collected medical history information, including cardiovascular risk factors. Starting in 1978, the researchers began collecting information on the type of hormones taken and, starting in 1980, on the dose of estrogen. Further follow-up surveys continued to update information on hormone use and asked whether the women had had a heart attack or stroke. The researchers confirmed all reported events, including deaths, by examining medical records and death certificates.
What did the researchers find?
Women who took hormones were 40% less likely to have a heart attack than those who never used hormones. The risk was reduced by about the same amount regardless of whether women had taken high or low doses of estrogen. No difference in the risk for stroke was found between hormone users and nonusers. However, women who took 0.625 mg or more of oral conjugated estrogen per day (an average dose) and those who took estrogen with a progestin hormone had a higher risk for stroke than women who never used hormones. Overall, women who had used postmenopausal hormones were about 23% less likely to have a heart attack or stroke than women who had never taken them.
What were the limitations of the study?
Women who decide to take hormones may be healthier to start with and may have healthier diets and activity levels than women who do not take hormones. These other factors, rather than hormones, could explain the differences between the groups in the risk for cardiovascular disease events.
What are the implications of the study?
Postmenopausal hormones may play a role in the primary prevention of cardiovascular disease. However, some hormone doses or combinations may increase the risk for stroke while decreasing the risk for heart attack.
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E Lokkegaard, A T Pedersen, B L Heitmann, Z Jovanovic, N Keiding, Y A Hundrup, E B Obel, and B Ottesen Relation between hormone replacement therapy and ischaemic heart disease in women: prospective observational study BMJ, February 22, 2003; 326(7386): 426 - 426. [Abstract] [Full Text] [PDF]
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 F. Grodstein, T. B. Clarkson, and J. E. Manson Understanding the Divergent Data on Postmenopausal Hormone Therapy N. Engl. J. Med., February 13, 2003; 348(7): 645 - 650. [Full Text] [PDF]
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W. W. Parmley In the statin era, how important are intense lifestyle changes? J. Am. Coll. Cardiol., January 15, 2003; 41(2): 273 - 274. [Full Text] [PDF]
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F. Grodstein and J. E. Manson Relationship Between Hormone Replacement Therapy, Socioeconomic Status, and Coronary Heart Disease JAMA, January 1, 2003; 289(1): 44 - 44. [Full Text] [PDF]
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N. Radford, T. Church, F. E. Speizer, B. E. Pearson Murphy, S. R. Davis, H. G. Burger, W. H. Goodson III, H. R. Franke, I. Lev, A. Lahad, et al. Risks of Postmenopausal Hormone Replacement JAMA, December 11, 2002; 288(22): 2819 - 2824. [Full Text] [PDF]
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T. B. Clarkson, M. S. Anthony, T. S. Mikkola, and R. W. St Clair Comparison of Tibolone and Conjugated Equine Estrogens Effects on Carotid Artery Atherosclerosis of Postmenopausal Monkeys Stroke, November 1, 2002; 33(11): 2700 - 2703. [Abstract] [Full Text] [PDF]
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M. J. Evans, H. A. Harris, C. P. Miller, S. K. Karathanasis, and S. J. Adelman Estrogen Receptors {alpha} and {beta} Have Similar Activities in Multiple Endothelial Cell Pathways Endocrinology, October 1, 2002; 143(10): 3785 - 3795. [Abstract] [Full Text] [PDF]
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 K. L. Moreau, A. J. Donato, D. R. Seals, F. A. Dinenno, S. D. Blackett, G. L. Hoetzer, C. A. Desouza, and H. Tanaka Arterial intima-media thickness: site-specific associations with HRT and habitual exercise Am J Physiol Heart Circ Physiol, October 1, 2002; 283(4): H1409 - H1417. [Abstract] [Full Text] [PDF]
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L. Molero, M. Garcia-Duran, J. Diaz-Recasens, L. Rico, S. Casado, and A. Lopez-Farre Expression of estrogen receptor subtypes and neuronal nitric oxide synthase in neutrophils from women and men: Regulation by estrogen Cardiovasc Res, October 1, 2002; 56(1): 43 - 51. [Abstract] [Full Text] [PDF]
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R. N. Lemaitre, S. R. Heckbert, B. M. Psaty, N. L. Smith, R. C. Kaplan, and W. T. Longstreth Jr Hormone Replacement Therapy and Associated Risk of Stroke in Postmenopausal Women Arch Intern Med, September 23, 2002; 162(17): 1954 - 1960. [Abstract] [Full Text] [PDF]
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 R. N. Butler, M. Fossel, S. M. Harman, C. B. Heward, S. J. Olshansky, T. T. Perls, D. J. Rothman, S. M. Rothman, H. R. Warner, M. D. West, et al. Is There an Antiaging Medicine? J. Gerontol. A Biol. Sci. Med. Sci., September 1, 2002; 57(9): B333 - 338. [Abstract] [Full Text] [PDF]
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K. K. Koh Effects of estrogen on the vascular wall: vasomotor function and inflammation Cardiovasc Res, September 1, 2002; 55(4): 714 - 726. [Full Text] [PDF]
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H. D. Nelson, L. L. Humphrey, P. Nygren, S. M. Teutsch, and J. D. Allan Postmenopausal Hormone Replacement Therapy: Scientific Review JAMA, August 21, 2002; 288(7): 872 - 881. [Abstract] [Full Text] [PDF]
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L. L. Humphrey, B. K.S. Chan, and H. C. Sox Postmenopausal Hormone Replacement Therapy and the Primary Prevention of Cardiovascular Disease Ann Intern Med, August 20, 2002; 137(4): 273 - 284. [Abstract] [Full Text] [PDF]
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W. L. Isley Growth Hormone Therapy for Adults: Not Ready for Prime Time? Ann Intern Med, August 6, 2002; 137(3): 190 - 196. [Abstract] [Full Text] [PDF]
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 A. Day Lessons from the Women's Health Initiative: primary prevention and gender health Can. Med. Assoc. J., August 1, 2002; 167(4): 361 - 362. [Full Text] [PDF]
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Writing Group for the Women's Health Initiative In Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women's Health Initiative Randomized Controlled Trial JAMA, July 17, 2002; 288(3): 321 - 333. [Abstract] [Full Text] [PDF]
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D. Grady A 60-Year-Old Woman Trying to Discontinue Hormone Replacement Therapy JAMA, April 24, 2002; 287(16): 2130 - 2137. [Full Text] [PDF]
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E. Barrett-Connor, D. Grady, A. Sashegyi, P. W. Anderson, D. A. Cox, K. Hoszowski, P. Rautaharju, K. D. Harper, and for the MORE Investigators Raloxifene and Cardiovascular Events in Osteoporotic Postmenopausal Women: Four-Year Results From the MORE (Multiple Outcomes of Raloxifene Evaluation) Randomized Trial JAMA, February 20, 2002; 287(7): 847 - 857. [Abstract] [Full Text] [PDF]
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T. S Mikkola and T. B Clarkson Estrogen replacement therapy, atherosclerosis, and vascular function Cardiovasc Res, February 15, 2002; 53(3): 605 - 619. [Abstract] [Full Text] [PDF]
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