Postmenopausal hormone use in women with acute coronary syndromes.
BACKGROUND
Recent trials reveal no benefit and possible harm from chronic hormone replacement therapy (HRT). Less is known about intermediate-term outcomes associated with HRT use in the setting of acute coronary syndromes (ACS).


METHODS
To examine the prevalence of HRT use and relationships with intermediate-term outcomes among women with ACS, we classified as HRT users or nonusers 4029 postmenopausal women (age > 50 years or postmenopausal by case report form) randomized in the Sibrafiban versus Aspirin to Yield Maximum Protection from Ischemic Heart Events Post-Acute Coronary Syndromes (SYMPHONY) and 2nd SYMPHONY trials. Outcomes included 90-day and 1-year death and 90-day stroke, death, or myocardial infarction (MI); death, MI, or stroke; and death, MI, or severe recurrent ischemia (SRI).


RESULTS
HRT use was 13% overall and varied by region (Asia, 0%; Eastern Europe, 0.2%; Latin America, 0.8%; Western Europe, 4%; Australia/New Zealand, 12%; Canada, 14%; United States, 24%); estrogen-only regimens were most common (90%). HRT users were younger, had higher estimated creatinine clearance, more frequently were smokers and had prior revascularization, but less frequently had diabetes, prior angina, or heart failure. Unadjusted 90-day and 1-year mortality rates were lower among HRT users (hazard ratios [95% CI] 0.48 [0.23-0.98] and 0.35 [0.18-0.68], respectively) but after multivariable adjustment, were not significantly different. Ninety-day stroke and composite end points did not differ between HRT users and nonusers.


CONCLUSIONS
HRT use (predominantly estrogen-only) was low among patients with ACS but varied by region and was not associated with improved intermediate-term outcomes. These results are consistent with the absence of benefit from HRT use (combination or estrogen only) in previous studies in more stable populations.
Parsons
Elizabeth
E
Duke University School of Medicine, Durham, North Carolina, USA.
Newby
L Kristin
LK
Bhapkar
Manjushri V
MV
Alexander
Karen P
KP
White
Harvey D
HD
Shah
Svati H
SH
Bushnell
Cheryl D
CD
Califf
Robert M
RM
D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D001294:Attitude to Health; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D014943:Global Health; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D016017:Odds Ratio; D010091:Oximes / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017698:Postmenopause; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D016387:Women's Health
D010091:Oximes; D010880:Piperidines; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin; C100917:sibrafiban