Estrogens should not be initiated for the secondary prevention of coronary artery disease: a debate.
Randomized controlled clinical trials investigating disease outcomes provide the best evidence to guide clinical practice. In the case of coronary artery disease (CAD), the only major clinical trial that has been completed does not support the epidemiological and pathophysiological evidence that estrogen is a cardioprotective agent. In the Heart and Estrogen/progestin Replacement Study (HERS), hormone replacement therapy (HRT) was of no overall benefit in the secondary prevention of CAD events in postmenopausal women. In addition, HRT was associated with a threefold increase in thromboembolic events. Based on the clinical trial evidence, estrogen therapy should not be initiated for the secondary prevention of CAD.
Hulley
S
S
University of California San Francisco, San Francisco, California 94143, USA. shulley@epi.ucsf.edu
D003327:Coronary Disease / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D017698:Postmenopause / Q000378:metabolism; D011372:Progestins / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D004967:Estrogens; D008055:Lipids; D011372:Progestins