title: Effect of hormone replacement therapy on cardiovascular outcomes: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Hormone replacement therapy (HRT) is widely used to controlling menopausal symptoms and prevent adverse cardiovascular events. However, the benefit and risk of HRT on cardiovascular outcomes remains controversial.
  
  
  RESULTS
  We systematically searched the PubMed, EmBase, and Cochrane Central Register of Controlled Trials databases for obtaining relevant literature. All eligible trials reported on the effects of HRT on cardiovascular outcomes. We did a random effects meta-analysis to obtain summary effect estimates for the clinical outcomes with use of relative risks calculated from the raw data of included trials. Of 1903 identified studies, we included 10 trials reporting data on 38908 postmenopausal women. Overall, we noted that estrogen combined with medroxyprogesterone acetate therapy as compared to placebo had no effect on coronary events (RR, 1.07; 95%CI: 0.91-1.26; P = 0.41), myocardial infarction (RR, 1.09; 95%CI: 0.85-1.41; P = 0.48), stroke (RR, 1.21; 95%CI: 1.00-1.46; P = 0.06), cardiac death (RR, 1.19; 95%CI: 0.91-1.56; P = 0.21), total death (RR, 1.06; 95%CI: 0.81-1.39; P = 0.66), and revascularization (RR, 0.95; 95%CI: 0.83-1.08; P = 0.43). In addition, estrogen therapy alone had no effect on coronary events (RR, 0.93; 95%CI: 0.80-1.08; P = 0.33), myocardial infarction (RR, 0.95; 95%CI: 0.78-1.15; P = 0.57), cardiac death (RR, 0.86; 95%CI: 0.65-1.13; P = 0.27), total mortality (RR, 1.02; 95%CI: 0.89-1.18; P = 0.73), and revascularization (RR, 0.77; 95%CI: 0.45-1.31; P = 0.34), but associated with a 27% increased risk for incident stroke (RR, 1.27; 95%CI: 1.06-1.53; P = 0.01).
  
  
  CONCLUSIONS
  Hormone replacement therapy does not effect on the incidence of coronary events, myocardial infarction, cardiac death, total mortality or revascularization. However, it might contributed an important role on the risk of incident stroke.
authors.affiliation: Department of Cardiovascular Surgery, Shanghai First People's Hospital affiliated to Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Dicheng
authors.initials: D
authors.lastname: Yang
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Zhongxiang
authors.initials: Z
authors.lastname: Yuan
authors.forename: Xu
authors.initials: X
authors.lastname: Liu
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D004967:Estrogens / Q000494:pharmacology*; D005260:Female; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000494:pharmacology*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D004967:Estrogens; D017258:Medroxyprogesterone Acetate