The long-term impact of 2 – 3 years of hormone replacement therapy on cardiovascular mortality and atherosclerosis in healthy women

Abstract

Objective The effect of hormone replacement therapy (HRT) on cardiovascular risk is intensely debated. The aim of this study was to investigate the long-term effects of HRT given for a few years on all-cause and cardiovascular mortality and the severity of atherosclerosis.

Methods This analysis was based on a cohort of 1458 postmenopausal women (55.8 ± 6.1 years old) who previously participated in a number of randomized, placebo-controlled, clinical trials assessing the efficacy of 2–3 years of therapy with various estrogen plus progestin combinations for preventing bone loss. Women were followed on average for 9.8 years and came for a follow-up visit. Outcome variables were all-cause and cardiovascular mortality and the severity of atherosclerosis, as estimated by semi-quantitative scoring of vascular calcification in the lumbar aorta on lateral radiographs.

Results A total of 174 women died during the observation period. All-cause mortality was decreased by 30% in the HRT+ group compared with the HRT− group (hazard ratio (HR) 0.70; 95% confidence interval (CI) 0.50–0.97) after adjusting for age, body mass index and smoking. Under the same conditions, similar results characterized mortality from cardiovascular disease (n = 61 deaths; 35.1% of all deaths) and coronary heart disease (n = 39 deaths; 22.4% of all deaths), which were decreased by 46% (HR 0.54, 95% CI 0.29–0.98, p = 0.045) and 53% (HR 0.47, 95% CI 0.21–1.03, p = 0.062), respectively. Furthermore, the mean severity score of aortic calcification at follow-up was significantly lower in hormone-treated compared to non-treated women (p < 0.0001).

Conclusion Women who receive 2–3 years of HRT after menopause do not have increased all-cause mortality, and results of the present study suggest relative cardiovascular benefits compared to those who had not used hormones.

Key words:

• Hormone replacement therapy
• Cardiovascular disease
• Mortality
• Atherosclerosis
• Women