title: Timing of hormone therapy, type of menopause, and coronary disease in women: data from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation.
abstract: OBJECTIVE
  The aim of this study was to assess the relationship of the timing of hormone therapy (HT) use with angiographic coronary artery disease (CAD) and cardiovascular disease (CVD) events in women with natural versus surgical menopause.
  
  
  METHODS
  We studied 654 postmenopausal women undergoing coronary angiography for the evaluation of suspected ischemia. Timing and type of menopause, HT use, and quantitative angiographic evaluations were obtained at baseline, and the women were followed for a median of 6 years for CVD events.
  
  
  RESULTS
  Ever users of HT had a significantly lower prevalence of obstructive CAD compared with never users (age-adjusted odds ratio, 0.41 [0.28-0.60]). Women with natural menopause initiating HT before age 55 years had lower CAD severity compared with never users (age-adjusted β [SE] = -6.23 [1.50], P < 0.0001), whereas those initiating HT at age 55 years or more did not differ statistically from never users (-3.34 [2.13], P = 0.12). HT use remained a significant predictor of obstructive CAD when adjusted for a "healthy user" model (odds ratio, 0.44 [0.30-0.73]; P = 0.002). An association between HT and fewer CVD events was observed only in the natural menopause group (hazard ratio [95% CI], 0.60 [0.41-0.88]; P = 0.009) but became nonsignificant when adjusted for the presence or severity of obstructive CAD.
  
  
  CONCLUSIONS
  Using the quantitative measurements of the timing and type of menopause and HT use, earlier initiation of HT was associated with less angiographic CAD in women with natural but not surgical menopause. Our data suggest that the effect of HT use on reduced cardiovascular event rates is mediated by the presence or absence of angiographic obstructive atherosclerosis.
authors.affiliation: Division of Cardiology, Heart Institute and Department of Medicine, Cedars-Sinai Medical Center, 444 S. San Vicente Blvd., Los Angeles, CA 90048, USA. shufeltc@cshs.org
authors.forename: Chrisandra L
authors.initials: CL
authors.lastname: Shufelt
authors.forename: B Delia
authors.initials: BD
authors.lastname: Johnson
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Berga
authors.forename: Glenn D
authors.initials: GD
authors.lastname: Braunstein
authors.forename: Steven E
authors.initials: SE
authors.lastname: Reis
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.forename: YuChing
authors.initials: Y
authors.lastname: Yang
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.forename: Barry L
authors.initials: BL
authors.lastname: Sharaf
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: Sheryl F
authors.initials: SF
authors.lastname: Kelsey
authors.forename: C Noel Bairey
authors.initials: CN
authors.lastname: Merz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008593:Menopause / Q000187:drug effects*; D008875:Middle Aged; D015995:Prevalence; D012720:Severity of Illness Index