Decreased mortality risk due to first acute coronary syndrome in women with postmenopausal hormone therapy use.
OBJECTIVE
The role of postmenopausal hormone therapy (HT) in the incidence of acute coronary syndrome (ACS) has been studied extensively, but less is known of the impact of HT on the mortality risk due to an ACS.


METHODS
We extracted from a population-based ACS register, FINAMI, 7258 postmenopausal women with the first ACS. These data were combined with HT use data from the National Drug Reimbursement Register; 625 patients (9%) had used various HT regimens. The death risks due to ACS before admission to hospital, 2-28, or 29-365days after the incident ACS were compared between HT users and non-users with logistic regression analyses.


RESULTS
In all follow-up time points, the ACS death risks in HT ever-users were smaller compared to non-users. Of women with HT ever use, 42% died within one year as compared with 52% of non-users (OR 0.62, p<0.001). Most deaths (84%) occurred within 28days after the ACS, and in this group 36% of women with ever use of HT (OR 0.73, p=0.002) and 30% of women with ≥5year HT use (OR 0.54, p<0.001) died as compared to 43% of the non-users. Age ≤60 or >60 years at the HT initiation was accompanied with similar reductions in ACS mortality risk.


CONCLUSIONS
Postmenopausal HT use is accompanied with reduced mortality risk after primary ACS.
University of Helsinki and Helsinki University Hospital, Department of Obstetrics and Gynecology, 00029 Helsinki, Finland.
Pauliina
P
Tuomikoski
THL-National Institute for Health and Welfare, PO BOX 30, 00271 Helsinki, Finland.
Veikko
V
Salomaa
THL-National Institute for Health and Welfare, PO BOX 30, 00271 Helsinki, Finland.
Aki
A
Havulinna
Heart Center, Turku University Hospital and Department of Clinical Medicine, University of Turku, Turku, Finland.
Juhani
J
Airaksinen
Central Hospital of North Karelia, Joensuu, Finland.
Matti
M
Ketonen
University of Eastern Finland, Kuopio, Finland.
Heli
H
Koukkunen
Research Institute of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
Olavi
O
Ukkola
Research Institute of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
Y Antero
YA
Kesäniemi
University of Helsinki and Helsinki University Hospital, Department of Obstetrics and Gynecology, 00029 Helsinki, Finland.
Heli
H
Lyytinen
University of Helsinki and Helsinki University Hospital, Department of Obstetrics and Gynecology, 00029 Helsinki, Finland.
Olavi
O
Ylikorkala
University of Helsinki and Helsinki University Hospital, Department of Obstetrics and Gynecology, 00029 Helsinki, Finland; Folkhälsan Research Center, Biomedicum, 00029 Helsinki, Finland. Electronic address: tomi.mikkola@hus.fi.
Tomi S
TS
Mikkola
D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D017698:Postmenopause; D012042:Registries; D012306:Risk
Case fatality; Estrogen; Myocardial infarction