title: Oestrogen therapy for prevention of reinfarction in postmenopausal women: a randomised placebo controlled trial.
abstract: BACKGROUND
  Results of observational studies suggest that hormone replacement therapy (HRT) could reduce the risk of coronary heart disease (CHD), but those of randomised trials do not indicate a lower risk in women who use oestrogen plus progestagen. The aim of this study was to ascertain whether or not unopposed oestrogen reduces the risk of further cardiac events in postmenopausal women who survive a first myocardial infarction.
  
  
  METHODS
  The study was a randomised, blinded, placebo controlled, secondary prevention trial of postmenopausal women, age 50-69 years (n=1017) who had survived a first myocardial infarction. Individuals were recruited from 35 hospitals in England and Wales. Women received either one tablet of oestradiol valerate (2 mg; n=513) or placebo (n=504), daily for 2 years. Primary outcomes were reinfarction or cardiac death, and all-cause mortality. Analyses were by intention-to-treat. Secondary outcomes were uterine bleeding, endometrial cancer, stroke or other embolic events, and fractures.
  
  
  RESULTS
  Frequency of reinfarction or cardiac death did not differ between treatment groups at 24 months (rate ratio 0.99, 95% CI 0.70-1.41, p=0.97). Similarly, the reduction in all-cause mortality between those who took oestrogen and those on placebo was not significant (0.79, 0.50-1.27, p=0.34). The relative risk of any death (0.56, 0.23-1.33) and cardiac death (0.33, 0.11-1.01) was lowest at 3 months post-recruitment.
  
  
  CONCLUSIONS
  Oestradiol valerate does not reduce the overall risk of further cardiac events in postmenopausal women who have survived a myocardial infarction.
authors.affiliation: Department of Public Health Sciences, University of Alberta, Edmonton, Canada. nicola.cherry@ualberta.ca
authors.forename: Nicola
authors.initials: N
authors.lastname: Cherry
authors.forename: Kyle
authors.initials: K
authors.lastname: Gilmour
authors.forename: Philip
authors.initials: P
authors.lastname: Hannaford
authors.forename: Anthony
authors.initials: A
authors.lastname: Heagerty
authors.forename: Mohammed Amjed
authors.initials: MA
authors.lastname: Khan
authors.forename: Henry
authors.initials: H
authors.lastname: Kitchener
authors.forename: Roseanne
authors.initials: R
authors.lastname: McNamee
authors.forename: Max
authors.initials: M
authors.lastname: Elstein
authors.forename: Clifford
authors.initials: C
authors.lastname: Kay
authors.forename: Mourad
authors.initials: M
authors.lastname: Seif
authors.forename: Hilary
authors.initials: H
authors.lastname: Buckley
mesh_terms: D000368:Aged; D004958:Estradiol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D010349:Patient Compliance; D017698:Postmenopause; D055502:Secondary Prevention; D006113:United Kingdom
chemical_list: D004958:Estradiol