Alternative hormone replacement regimens: is there a need for further clinical trials?
OBJECTIVE
To review the randomized trials of hormone replacement therapy.


RESULTS
Studies have shown that conjugated equine estrogen 0.625 mg a day plus medroxyprogesterone acetate 2.5 mg a day increased the risk of cardiovascular events during the first year of treatment in women both with and without coronary heart disease. Conjugated equine estrogen plus medroxyprogesterone acetate also increased the overall risk of myocardial infarction and stroke in women without coronary heart disease, and myocardial infarction or death in women with coronary heart disease, and also increased the risk of breast cancer, cognitive decline and dementia. Unopposed, oral 17B-estradiol increased the risk of stroke during the first 6 months of treatment in women with a previous stroke. Oral 17B-estradiol with or without cyclic progestin had no effect on the progression of atherosclerosis or reinfarction. Transdermal 17B-estradiol plus cyclic progestin was associated with a non-significant increase in coronary heart disease events in women with coronary heart disease. Compared with placebo, cardiovascular events increased in the ongoing estrogen-only arm of the Women's Health Initiative, indicating that unopposed conjugated equine estrogen is unlikely to be cardioprotective. However, oral 17B-estradiol retarded the progression of subclinical atherosclerosis in younger women without coronary heart disease.


CONCLUSIONS
Hormone replacement therapy should not be initiated for the primary or secondary prevention of coronary heart disease in women. A trial of 17B-estradiol started at menopause in women without coronary heart disease should be considered.
Welty
Francine K
FK
Division of Cardiology, Beth Israel Deaconess Medical Center, One Autumn Street, 5th Floor, Boston, MA 02215, USA. fwelty@caregroup.harvard.edu
D000279:Administration, Cutaneous; D000284:Administration, Oral; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D002340:Carotid Artery Diseases / Q000209:etiology / Q000517:prevention & control; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control; D004958:Estradiol / Q000008:administration & dosage / Q000627:therapeutic use; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D016896:Treatment Outcome
D004966:Estrogens, Conjugated (USP); D004958:Estradiol; D017258:Medroxyprogesterone Acetate