Statin therapy, cardiovascular events, and total mortality in the Heart and Estrogen/Progestin Replacement Study (HERS).
BACKGROUND
Although effects of statins on cardiovascular outcomes are well established in men, fewer data exist for women. Furthermore, the effects of statins plus hormone replacement therapy (HRT) on cardiovascular outcomes are uncertain.


RESULTS
We examined statin use, cardiovascular events, and total mortality in the Heart and Estrogen/progestin Replacement Study (HERS), a randomized clinical trial of estrogen plus progestin versus placebo in postmenopausal women with heart disease (n=2763). A nonrandomized comparison of statin users and nonusers revealed lower rates of the primary outcome, nonfatal myocardial infarction or coronary heart disease death (relative hazard [RH]=0.79, 95% confidence intervals [CI] 0.63 to 0.99, P=0.04), and total mortality (RH=0.67, 95% CI 0.51 to 0.87, P=0.003). Rates of venous thromboembolic events were also lower among statin users (RH=0.45, 95% CI 0.23 to 0.88, P=0.02). HRT resulted in a significant increase in early risk for primary events in women who did not use statins (RH=1.75, 95% CI 1.02 to 3.03, P=0.04) but not in statin users (RH=1.34, 95% CI 0.63 to 2.86, P=0.45). Adjustment for postrandomization statin use showed no effect of HRT on risk for the primary outcome (RH=0.96, 95% CI 0.77 to 1.29; P=0.72).


CONCLUSIONS
In HERS, statin use was associated with lower rates of cardiovascular events, venous thromboembolic events, and total mortality. These data provide strong support for statin use in eligible women with coronary disease.
Herrington
David M
DM
Department of Internal Medicine/Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. dherring@wfubmc.edu
Vittinghoff
Eric
E
Lin
Feng
F
Fong
Josephine
J
Harris
Fran
F
Hunninghake
Donald
D
Bittner
Vera
V
Schrott
Helmut G
HG
Blumenthal
Roger S
RS
Levy
Robert
R
D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003327:Coronary Disease / Q000188:drug therapy* / Q000401:mortality*; D004347:Drug Interactions; D015914:Estrogen Replacement Therapy; D004966:Estrogens, Conjugated (USP) / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D017698:Postmenopause; D013923:Thromboembolism / Q000453:epidemiology / Q000517:prevention & control
D004966:Estrogens, Conjugated (USP); D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017258:Medroxyprogesterone Acetate