title: Hormone therapy for preventing cardiovascular disease in post-menopausal women.
abstract: BACKGROUND
  Evidence from systematic reviews of observational studies suggest that hormone replacement therapy (HT) may have beneficial effects in reducing the incidence of cardiovascular disease (CVD) events in post-menopausal women. This is an updated version of a Cochrane review first published in 2005 (Gabriel-Sanchez 2005).
  
  
  OBJECTIVE
  To assess the effects of HT for the prevention of CVD in post-menopausal women, and whether there are differential effects between use of single therapy alone compared to combination HT and use in primary or secondary prevention.
  
  
  METHODS
  We searched the following databases to April 2010: Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, MEDLINE, EMBASE and LILACS.
  
  
  METHODS
  Randomised controlled trials (RCTs) of women comparing orally administered HT with placebo with a minimum of six-months follow-up.
  
  
  METHODS
  Two authors independently assessed study quality and extracted data. Risk Ratios (RR) with 95% confidence intervals were calculated for each outcome. Results were combined using fixed-effect meta-analyses, and where possible, further stratified analyses conducted to assess the effect of time on treatment. Additionally, univariate meta-regression analyses were undertaken to assess whether length of trial follow-up, single or combination treatment, or whether treatment for primary or secondary prevention were potential predictors for a number of CVD outcomes in the trials.
  
  
  RESULTS
  Four new trials were identified through the update; one trial included in the previous review was excluded. Therefore the review included 13 trials with a total of 38,171 post-menopausal women. Overall, single and combination HT in both primary and secondary prevention conferred no protective effects for all cause mortality, CVD death, non-fatal MI, or angina. There were no significant differences in the number of coronary artery by-pass procedures or angioplasties performed between the trial arms. However there was an increased risk of stroke for both primary and secondary prevention when combination and single HT was combined, RR 1.26 (95% CI 1.11 to 1.43), in venous thromboembolic events, RR 1.89 (95% CI 1.58 to 2.26) and in pulmonary embolism RR 1.84 (95% CI 1.42 to 2.37) relative to placebo. The associated numbers needed-to-harm (NNH) were 164, 109 and 243 for stroke, venous thromboembolism and pulmonary embolism respectively.
  
  
  CONCLUSIONS
  Treatment with HT in post-menopausal women for either primary or secondary prevention of CVD events is not effective, and causes an increase in the risk of stroke, and venous thromboembolic events. HT should therefore only be considered for women seeking relief from menopausal symptoms. Short-term HT treatment should be at the lowest effective dose, and used with caution in women with predisposing risk factors for CVD events.
authors: Peninsula Technology Assessment Group (PenTAG), Peninsula College of Medicine and Dentistry, Exeter, UK. carriemain24@gmail.com.
authors: Caroline
authors: C
authors: Main
authors: Beatrice
authors: B
authors: Knight
authors: Tiffany
authors: T
authors: Moxham
authors: Rafael
authors: R
authors: Gabriel Sanchez
authors: Luis Maria
authors: LM
authors: Sanchez Gomez
authors: Marta
authors: M
authors: Roqué i Figuls
authors: Xavier
authors: X
authors: Bonfill Cosp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D020521:Stroke / Q000139:chemically induced; D054556:Venous Thromboembolism / Q000139:chemically induced