Hormone replacement therapy and the risk of incident congestive heart failure: the Cardiovascular Health Study.
BACKGROUND
The development of congestive heart failure (CHF) in older persons is related to a variety of mechanisms. Hormone replacement therapy (HRT) affects several of the pathways that may be important in the development of CHF. We hypothesized that HRT would be associated with a decreased risk of incident CHF.


METHODS
Using Cox proportional-hazards regression, we assessed the risk of incident CHF (n = 304) associated with time-dependent past and current use of HRT compared to never use. The Cardiovascular Health Study is a prospective cohort study of community-dwelling adults aged 65 years and older. This analysis included female participants without a history of CHF at baseline (n = 3223).


RESULTS
At baseline, 62% were never users, 26% were past users, and 12% were current users of HRT. Compared with never users, the multivariable relative risk (RR) of CHF was 1.01 (95% confidence interval [95% CI] 0.76,1.34) for past users and 1.34 (0.93,1.94) for current users. Results were similar among most treatment and clinical subgroups, except that the association of current HRT with CHF appeared to depend on body mass index (BMI) or osteoporosis status. The RR was 0.82 (0.43,1.60) for normal weight women, 1.65 (0.95,2.88) for overweight women, and 2.22 (1.06,4.67) for obese women (p = 0.01 for interaction). Similarly, the RR was 0.15 (0.04,0.65) for women with osteoporosis and 1.82 (1.25,2.65) for women without osteoporosis (p = 0.001 for interaction).


CONCLUSIONS
Overall, HRT was not associated with the risk of incident CHF, although BMI and osteoporosis appeared to modify the association of HRT with CHF. The risk of CHF was lower in patients with lower BMI or osteoporosis.
Rea
Thomas D
TD
Cardiovascular Health Research Unit, University of Washington, Metropolitan Park, East Tower, 1730 Minor Avenue, Seattle, WA 98101, USA. rea123@u.washington.edu
Psaty
Bruce M
BM
Heckbert
Susan R
SR
Cushman
Mary
M
Meilahn
Elaine
E
Olson
Jean L
JL
Lemaitre
Rozenn N
RN
Smith
Nicholas L
NL
Sotoodehnia
Nona
N
Chaves
Paulo H M
PH
D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D015914:Estrogen Replacement Therapy; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008019:Life Style; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D015663:Osteoporosis, Postmenopausal / Q000150:complications; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D016387:Women's Health