title: Postmenopausal hormone use in women with acute coronary syndromes.
abstract: 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.
authors.affiliation: Duke University School of Medicine, Durham, North Carolina, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Parsons
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
authors.forename: Manjushri V
authors.initials: MV
authors.lastname: Bhapkar
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.forename: Svati H
authors.initials: SH
authors.lastname: Shah
authors.forename: Cheryl D
authors.initials: CD
authors.lastname: Bushnell
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
mesh_terms: 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
chemical_list: D010091:Oximes; D010880:Piperidines; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin; C100917:sibrafiban