HRT as secondary prevention of cardiovascular disease.
OBJECTIVE
To review the evidence of the efficacy of postmenopausal hormone replacement therapy (HRT) in secondary prevention of coronary artery disease or stroke.


RESULTS
Although a number of rather large and prolonged non-randomized observational studies have produced convincing and consistent evidence of the efficacy of HRT in the prevention of recurrence of cardiac events, the first randomized, placebo controlled trial (RCT) on heart disease and estrogen replacement study (HERS) reported no benefit of conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA) in secondary prevention of cardiac events in women with established coronary artery disease. This was supported by RCT reporting no effect of CEE or CEE + MPA on the progress of coronary sclerosis. Similarly, some nonrandomized observational studies have evaluated the risk of recurrent stroke in regard to the use of HRT, and the data are conflicting reporting a reduced or increased risk of recurrence for HRT users. One RCT has shown that low-dose estrogen treatment can only slow down the progression of carotid arteriosclerosis in high-risk postmenopausal women, whereas two other RCTs have shown no benefit (or risk) of using HRT for secondary prevention of ischemic stroke or progression of carotid atherosclerosis.


CONCLUSIONS
The evidence accumulated so far shows that HRT has no place in secondary prevention of coronary or carotic artery disease. Its use in these patients must be based on solid nonvascular indications and expected benefits from these causes.
Ylikorkala
Olavi
O
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, POB 140, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland. olavi.ylikorkala@hus.fi
D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015914:Estrogen Replacement Therapy; D006801:Humans; D016032:Randomized Controlled Trials as Topic