Postmenopausal hormone therapy increases risk for venous thromboembolic disease. The Heart and Estrogen/progestin Replacement Study.
BACKGROUND
Oral contraceptive use increases risk for venous thromboembolism, but data on the effect of postmenopausal hormone therapy are limited.


OBJECTIVE
To determine the effect of therapy with estrogen plus progestin on risk for venous thromboembolic events in postmenopausal women.


METHODS
Randomized, double-blind, placebo-controlled trial.


METHODS
20 clinical centers in the United States.


METHODS
2763 postmenopausal women younger than 80 years of age (mean age, 67 years) who had coronary heart disease but no previous venous thromboembolism and had not had a hysterectomy.


METHODS
Conjugated equine estrogens, 0.625 mg, plus medroxyprogesterone acetate, 2.5 mg, in one tablet (n = 1380) or placebo that was identical in appearance (n = 1383).


METHODS
Documented deep venous thrombosis or pulmonary embolism.


RESULTS
During an average of 4.1 years of follow-up, 34 women in the hormone therapy group and 13 in the placebo group experienced venous thromboembolic events (relative hazard, 2.7 [95% CI, 1.4 to 5.0] [P = 0.003]; excess risk, 3.9 per 1000 woman-years [CI, 1.4 to 6.4 per 1000 woman-years]; number needed to treat for harm, 256 [CI, 157 to 692]). In multivariate analysis, the risk for venous thromboembolism was increased among women who had lower-extremity fractures (relative hazard, 18.1 [CI, 5.4 to 60.4]) or cancer (relative hazard, 3.9 [CI, 1.6 to 9.4]) and for 90 days after inpatient surgery (relative hazard, 4.9 [CI, 2.4 to 9.8]) or nonsurgical hospitalization (relative hazard, 5.7 [CI, 3.0 to 10.8]). Risk was decreased with aspirin (relative hazard, 0.5 [CI, 0.2 to 0.8]) or statin use (relative hazard, 0.5 [CI, 0.2 to 0.9]).


CONCLUSIONS
Postmenopausal therapy with estrogen plus progestin increases risk for venous thromboembolism in women with coronary heart disease. This risk should be considered when the risks and benefits of therapy are being weighed.
Grady
D
D
University of California, San Francisco, 94105, USA.
Wenger
N K
NK
Herrington
D
D
Khan
S
S
Furberg
C
C
Hunninghake
D
D
Vittinghoff
E
E
Hulley
S
S
D000368:Aged; D003327:Coronary Disease / Q000150:complications; D004311:Double-Blind Method; D004338:Drug Combinations; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D004966:Estrogens, Conjugated (USP) / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000150:complications; D006760:Hospitalization; D006801:Humans; D007869:Leg Injuries / Q000150:complications; D008525:Medroxyprogesterone / Q000009:adverse effects*; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications; D016016:Proportional Hazards Models; D011655:Pulmonary Embolism / Q000209:etiology*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D020246:Venous Thrombosis / Q000209:etiology*
D004338:Drug Combinations; D004966:Estrogens, Conjugated (USP); D008525:Medroxyprogesterone