title: Initiation of hormone replacement therapy after acute myocardial infarction is associated with more cardiac events during follow-up.
abstract: OBJECTIVE
  This study explored the association between the initiation of hormone replacement therapy (HRT) and early cardiac events (<1 year) in women with a recent myocardial infarction (MI).
  
  
  BACKGROUND
  Observational studies have linked postmenopausal hormone use with a reduced risk of death from heart disease. However, a recent randomized trial of HRT found no long-term benefit, primarily due to an increase in cardiac events in the first year.
  
  
  METHODS
  The Coumadin Aspirin Reinfarction Study (CARS) database contains information on HRT use and menopausal status for women with a recent MI. We classified the 1,857 postmenopausal women in CARS as prior/current HRT users if they took HRT before enrollment, new users if they began HRT during the study period or never users. We assessed the incidence of cardiac events (death, MI, unstable angina [UA]) during follow-up.
  
  
  RESULTS
  In our cohort, 28% (n = 524) used HRT at some point. Of these, 21% (n = 111) began HRT after their MI. New users had a higher incidence of death/MI/UA (41% vs. 28%, p = 0.001) during follow-up than never users, largely due to a higher incidence of UA (39% vs. 20%, p = 0.001). After adjustment, new users still had a significantly higher risk of death/MI/UA than never users during follow-up (relative risk [RR] = 1.44 [1.05-1.99]). Prior/current users had no excess risk of the composite end point after adjustment. Users of estrogen/progestin had a lower incidence of death/MI/UA during follow-up than users of estrogen only (RR = 0.56 [0.37-0.85]).
  
  
  CONCLUSIONS
  Postmenopausal women who initiated HRT after a recent MI had an increased risk of cardiac events largely due to excess UA during follow-up.
authors.affiliation: Outcomes Research and Assessment Group, The Duke Clinical Research Institute, Durham, North Carolina 27710, USA. alexa019@mc.duke.edu
authors.forename: K P
authors.initials: KP
authors.lastname: Alexander
authors.forename: L K
authors.initials: LK
authors.lastname: Newby
authors.forename: A S
authors.initials: AS
authors.lastname: Hellkamp
authors.forename: R A
authors.initials: RA
authors.lastname: Harrington
authors.forename: E D
authors.initials: ED
authors.lastname: Peterson
authors.forename: S
authors.initials: S
authors.lastname: Kopecky
authors.forename: A
authors.initials: A
authors.lastname: Langer
authors.forename: P
authors.initials: P
authors.lastname: O'Gara
authors.forename: C M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: R N
authors.initials: RN
authors.lastname: Daly
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: S
authors.initials: S
authors.lastname: Khan
authors.forename: V
authors.initials: V
authors.lastname: Fuster
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000209:etiology*; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000628:therapy*; D012008:Recurrence