title: Statin therapy, cardiovascular events, and total mortality in the Heart and Estrogen/Progestin Replacement Study (HERS).
abstract: 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.
authors.affiliation: Department of Internal Medicine/Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. dherring@wfubmc.edu
authors.forename: David M
authors.initials: DM
authors.lastname: Herrington
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Feng
authors.initials: F
authors.lastname: Lin
authors.forename: Josephine
authors.initials: J
authors.lastname: Fong
authors.forename: Fran
authors.initials: F
authors.lastname: Harris
authors.forename: Donald
authors.initials: D
authors.lastname: Hunninghake
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.forename: Helmut G
authors.initials: HG
authors.lastname: Schrott
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.forename: Robert
authors.initials: R
authors.lastname: Levy
mesh_terms: 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
chemical_list: D004966:Estrogens, Conjugated (USP); D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017258:Medroxyprogesterone Acetate