HRT and cardiovascular risk
admin July 13th, 2007
The BMJ has published the WISDOM Trial of HRT in postmenopausal women aged 50 to 69 years-of-age (mean age 62.8 SD 4.8).
Key points:
Combined hormone therapy (n=2196) was compared with placebo (n=2189):
- significant increase in the number of major cardiovascular events (7 v 0, P=0.016)
- significant increase in venous thromboembolisms (22 v 3, hazard ratio 7.36 (95% CI 2.20 to 24.60))
- no statistically significant differences in numbers of breast or other cancers (22 v 25, hazard ratio 0.88 (0.49 to 1.56)), cerebrovascular events (14 v 19, 0.73 (0.37 to 1.46)), fractures (40 v 58, 0.69 (0.46 to 1.03)), and overall deaths (8 v 5, 1.60 (0.52 to 4.89)).
Comparison of combined hormone therapy (n=815) versus oestrogen therapy (n=826) outcomes:
- no significant differences.
The study authors argue that this trial is consistent with the Womens’ Health Initiative trial, showing increased risks associated with HRT when used in older post-menopausal women. It is less useful in casting light on the risk to women who are younger and who are using HRT to deal with menopausal symptoms. An accompanying editorial argues that:
So postmenopausal hormone therapy has come full circle.9 It was originally used to treat menopausal symptoms, and now the indications for use are again hot flushes, night sweats, and vaginal dryness. It is the best treatment we have at present for these symptoms. Hot flushes and night sweats are mostly self limiting, and current advice recommends short term use with the lowest dose needed for relief of symptoms. Healthy women in early menopause are at a low absolute risk whether they take hormones or not, and they are unlikely to face substantially increased risks when using hormones for a few years.
Long term use of hormone replacement therapy to prevent chronic disease is no longer recommended, because available randomised evidence shows that the negative outcomes outweigh the positive benefits.