 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Postmenopausal Hormone Use and Primary Prevention of Heart Disease and Stroke in Healthy Women
19 December 2000 | Volume 133 Issue 12 | Page S60
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician.
The summary below is from the full report titled "A Prospective, Observational Study of Postmenopausal Hormone Therapy and Primary Prevention of Cardiovascular Disease." It is in the 19 December 2000 issue of Annals of Internal Medicine (volume 133, pages 933-941). The authors are F Grodstein, JE Manson, GA Colditz, WC Willett, FE Speizer, and MJ Stampfer.
What is the problem and what is known about it so far?
Primary prevention means preventing a disease in persons with no history of the disease; secondary prevention means preventing recurrence or progression of the disease in persons who already have it. Many preliminary studies have suggested that treatment with hormones protects women from heart disease, but a recent large trial of hormone replacement therapy in women with heart disease (secondary prevention) indicated that the effects of hormone therapy on the heart may be somewhat complicated; it looked like more heart attacks and strokes occurred with short-term use of hormones, but that fewer such events occurred with longer-term hormone use. Information from similar trials about primary prevention is not available.
Why did the researchers do this particular study?
To get further information on whether postmenopausal women without previous heart attacks and strokes who take hormones have fewer cardiovascular events than women who do not.
Who was studied?
The researchers studied 70,533 postmenopausal female nurses who had no known history of previous cardiovascular disease.
How was the study done?
The women were surveyed in 1976 to find out whether they had ever used postmenopausal hormones. The survey also collected medical history information, including cardiovascular risk factors. Starting in 1978, the researchers began collecting information on the type of hormones taken and, starting in 1980, on the dose of estrogen. Further follow-up surveys continued to update information on hormone use and asked whether the women had had a heart attack or stroke. The researchers confirmed all reported events, including deaths, by examining medical records and death certificates.
What did the researchers find?
Women who took hormones were 40% less likely to have a heart attack than those who never used hormones. The risk was reduced by about the same amount regardless of whether women had taken high or low doses of estrogen. No difference in the risk for stroke was found between hormone users and nonusers. However, women who took 0.625 mg or more of oral conjugated estrogen per day (an average dose) and those who took estrogen with a progestin hormone had a higher risk for stroke than women who never used hormones. Overall, women who had used postmenopausal hormones were about 23% less likely to have a heart attack or stroke than women who had never taken them.
What were the limitations of the study?
Women who decide to take hormones may be healthier to start with and may have healthier diets and activity levels than women who do not take hormones. These other factors, rather than hormones, could explain the differences between the groups in the risk for cardiovascular disease events.
What are the implications of the study?
Postmenopausal hormones may play a role in the primary prevention of cardiovascular disease. However, some hormone doses or combinations may increase the risk for stroke while decreasing the risk for heart attack.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  E. Zhan, T. Keimig, J. Xu, E. Peterson, J. Ding, F. Wang, and X.-P. Yang Dose-dependent cardiac effect of oestrogen replacement in mice post-myocardial infarction Exp Physiol, August 1, 2008; 93(8): 982 - 993. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. A. Shively, T. C. Register, M. R. Adams, D. L. Golden, S. L. Willard, and T. B. Clarkson Depressive Behavior and Coronary Artery Atherogenesis in Adult Female Cynomolgus Monkeys Psychosom Med, July 1, 2008; 70(6): 637 - 645. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G.-C. M. Gast, D. E. Grobbee, V. J.M. Pop, J. J. Keyzer, C. J.M. Wijnands-van Gent, G. N. Samsioe, P. M. Nilsson, and Y. T. van der Schouw Menopausal Complaints Are Associated With Cardiovascular Risk Factors Hypertension, June 1, 2008; 51(6): 1492 - 1498. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Grodstein, J. E. Manson, M. J. Stampfer, and K. Rexrode Postmenopausal Hormone Therapy and Stroke: Role of Time Since Menopause and Age at Initiation of Hormone Therapy Arch Intern Med, April 28, 2008; 168(8): 861 - 866. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Marfella, C. Di Filippo, M. Portoghese, F. Ferraraccio, B. Crescenzi, M. Siniscalchi, M. Barbieri, C. Bologna, M. R. Rizzo, F. Rossi, et al. Proteasome Activity as a Target of Hormone Replacement Therapy-Dependent Plaque Stabilization in Postmenopausal Women Hypertension, April 1, 2008; 51(4): 1135 - 1141. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. H. Sanders, J. M. Montserrat, R. Farre, and R. J. Givelber Positive Pressure Therapy: A Perspective on Evidence-based Outcomes and Methods of Application Proceedings of the ATS, February 15, 2008; 5(2): 161 - 172. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.-N. Vercambre, A. Fournier, M.-C. Boutron-Ruault, F. Clavel-Chapelon, V. Ringa, and C. Berr Differential Dietary Nutrient Intake according to Hormone Replacement Therapy Use: An Underestimated Confounding Factor in Epidemiologic Studies? Am. J. Epidemiol., December 15, 2007; 166(12): 1451 - 1460. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. B. Ojeda, D. Grigore, E. B. Robertson, and B. T. Alexander Estrogen Protects Against Increased Blood Pressure in Postpubertal Female Growth Restricted Offspring Hypertension, October 1, 2007; 50(4): 679 - 685. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. E. Manson and S. S. Bassuk Invited Commentary: Hormone Therapy and Risk of Coronary Heart Disease Why Renew the Focus on the Early Years of Menopause? Am. J. Epidemiol., September 1, 2007; 166(5): 511 - 517. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Rajasingh, E. Bord, G. Qin, M. Ii, M. Silver, H. Hamada, D. Ahluwalia, D. Goukassian, Y. Zhu, D. W. Losordo, et al. Enhanced Voluntary Alcohol Consumption after Estrogen Supplementation Negates Estrogen-Mediated Vascular Repair in Ovariectomized Mice Endocrinology, August 1, 2007; 148(8): 3618 - 3624. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. E. Wierman and W. M. Kohrt Review Article: Vascular and Metabolic Effects of Sex Steroids: New Insights Into Clinical Trials Reproductive Sciences, May 1, 2007; 14(4): 300 - 314. [Abstract] [PDF]
|
|
|
|
 |
|
 J. E. Rossouw, R. L. Prentice, J. E. Manson, L. Wu, D. Barad, V. M. Barnabei, M. Ko, A. Z. LaCroix, K. L. Margolis, and M. L. Stefanick Postmenopausal Hormone Therapy and Risk of Cardiovascular Disease by Age and Years Since Menopause JAMA, April 4, 2007; 297(13): 1465 - 1477. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. de Lecinana, J. A. Egido, C. Fernandez, E. Martinez-Vila, S. Santos, A. Morales, E. Martinez, A. Pareja, J. Alvarez-Sabin, I. Casado, et al. Risk of ischemic stroke and lifetime estrogen exposure Neurology, January 2, 2007; 68(1): 33 - 38. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Tice, A. Kanaya, T. Hue, S. Rubin, D. S. M. Buist, A. LaCroix, J. V. Lacey Jr, J. A. Cauley, S. Litwack, L. A. Brinton, et al. Risk Factors for Mortality in Middle-aged Women Arch Intern Med, December 11, 2006; 166(22): 2469 - 2477. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Gingerich and T. L. Krukoff Estrogen in the Paraventricular Nucleus Attenuates L-Glutamate-Induced Increases in Mean Arterial Pressure Through Estrogen Receptor {beta} and NO Hypertension, December 1, 2006; 48(6): 1130 - 1136. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 The ESHRE Capri Workshop Group Hormones and cardiovascular health in women Hum. Reprod. Update, September 1, 2006; 12(5): 483 - 497. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. C. Stevenson and on behalf of the International Consensus Group on HRT, osteoporosis and regulatory authorities Quis custodiet ipsos custodes? Hum. Reprod., July 1, 2006; 21(7): 1668 - 1671. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Kim, S. Evans, L. Smeeth, and S. Pocock Hormone replacement therapy and acute myocardial infarction: a large observational study exploring the influence of age Int. J. Epidemiol., June 1, 2006; 35(3): 731 - 738. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Prentice, M. L. Stefanick, B. V. Howard, D. Barad, and L. Kuller FIVE AUTHORS REPLY Am. J. Epidemiol., June 1, 2006; 163(11): 1068 - 1069. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Ouyang, E. D. Michos, and R. H. Karas Hormone Replacement Therapy and the Cardiovascular System: Lessons Learned and Unanswered Questions J. Am. Coll. Cardiol., May 2, 2006; 47(9): 1741 - 1753. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. K. Koh and B.-K. Yoon Controversies regarding hormone therapy: Insights from inflammation and hemostasis Cardiovasc Res, April 1, 2006; 70(1): 22 - 30. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. L. Ballard and J. M. Edelberg Harnessing Hormonal Signaling for Cardioprotection Sci. Aging Knowl. Environ., December 21, 2005; 2005(51): re6 - re6. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Genuis The Proliferation of Clinical Practice Guidelines: Professional Development or Medicine-by-Numbers? J Am Board Fam Med, September 1, 2005; 18(5): 419 - 425. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. B. Petitti and D. A. Freedman Invited Commentary: How Far Can Epidemiologists Get with Statistical Adjustment? Am. J. Epidemiol., September 1, 2005; 162(5): 415 - 418. [Full Text] [PDF]
|
|
|
|
|
|
R. L. Prentice, R. Langer, M. L. Stefanick, B. V. Howard, M. Pettinger, G. Anderson, D. Barad, J. D. Curb, J. Kotchen, L. Kuller, et al. Combined Postmenopausal Hormone Therapy and Cardiovascular Disease: Toward Resolving the Discrepancy between Observational Studies and the Women's Health Initiative Clinical Trial Am. J. Epidemiol., September 1, 2005; 162(5): 404 - 414. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. P. Mayer, C. A. Dyer, R. L. Eastgard, P. B. Hoyer, and C. L. Banka Atherosclerotic Lesion Development in a Novel Ovary-Intact Mouse Model of Perimenopause Arterioscler. Thromb. Vasc. Biol., September 1, 2005; 25(9): 1910 - 1916. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. M. Miller, T. B. Clarkson, S. M. Harman, E. A. Brinton, M. Cedars, R. Lobo, J. E. Manson, G. R. Merriam, F. Naftolin, and N. Santoro Women, hormones, and clinical trials: a beginning, not an end J Appl Physiol, August 1, 2005; 99(2): 381 - 383. [Full Text] [PDF]
|
|
|
|
 |
|
 Y. T. van der Schouw and D. E. Grobbee Menopausal complaints, oestrogens, and heart disease risk: an explanation for discrepant findings on the benefits of post-menopausal hormone therapy Eur. Heart J., July 2, 2005; 26(14): 1358 - 1361. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. K. Koh, S. H. Han, M.-S. Shin, J. Y. Ahn, Y. Lee, and E. K. Shin Significant differential effects of lower doses of hormone therapy or tibolone on markers of cardiovascular disease in post-menopausal women: a randomized, double-blind, crossover study Eur. Heart J., July 2, 2005; 26(14): 1362 - 1368. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. M. Goldstein, L. H. Harpole, K. M. Stechuchak, C. J. Coffman, H. B. Bosworth, D. C. Steffens, and L. A. Bastian Hormone Therapy Does Not Affect Depression Severity in Older Women Am J Geriatr Psychiatry, July 1, 2005; 13(7): 616 - 623. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. K. Dubey, B. Imthurn, M. Barton, and E. K. Jackson Vascular consequences of menopause and hormone therapy: Importance of timing of treatment and type of estrogen Cardiovasc Res, May 1, 2005; 66(2): 295 - 306. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Wakatsuki, K. K. Koh, E. K. Shin, and I. Sakuma Lower Doses of Estrogen Replacement Therapy and the Risk of Cardiovascular Disease Arterioscler. Thromb. Vasc. Biol., December 1, 2004; 24(12): e197 - e197. [Full Text] [PDF]
|
|
|
|
|
|
R. K. Dubey, B. Imthurn, L. C. Zacharia, and E. K. Jackson Hormone Replacement Therapy and Cardiovascular Disease: What Went Wrong and Where Do We Go From Here? Hypertension, December 1, 2004; 44(6): 789 - 795. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Coronary Heart Disease Obstet. Gynecol., October 1, 2004; 104(4_suppl): 41S - 48S. [Full Text] [PDF]
|
|
|
|
|
|
Stroke Obstet. Gynecol., October 1, 2004; 104(4_suppl): 97S - 105S. [Full Text] [PDF]
|
|
|
|
|
|
K. L. Brubaker Effects of Estrogen-Only Treatment in Postmenopausal Women JAMA, August 11, 2004; 292(6): 686 - 686. [Full Text] [PDF]
|
|
|
|
|
|
K. K. Koh, M.-S. Shin, I. Sakuma, J. Y. Ahn, D. K. Jin, H. S. Kim, D. S. Kim, S. H. Han, W.-J. Chung, and E. K. Shin Effects of Conventional or Lower Doses of Hormone Replacement Therapy in Postmenopausal Women Arterioscler. Thromb. Vasc. Biol., August 1, 2004; 24(8): 1516 - 1521. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Kang, J. Weuve, and F. Grodstein Postmenopausal hormone therapy and risk of cognitive decline in community-dwelling aging women Neurology, July 13, 2004; 63(1): 101 - 107. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. K. Koh and I. Sakuma Should Progestins Be Blamed for the Failure of Hormone Replacement Therapy to Reduce Cardiovascular Events in Randomized Controlled Trials? Arterioscler. Thromb. Vasc. Biol., July 1, 2004; 24(7): 1171 - 1179. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Stampfer Commentary: Hormones and heart disease: do trials and observational studies address different questions? Int. J. Epidemiol., June 1, 2004; 33(3): 454 - 455. [Full Text] [PDF]
|
|
|
|
 |
|
 F. Grodstein, J. E. Manson, M. J. Stampfer, and W. C. Willett The Discrepancy between Observational Studies and Randomized Trials of Menopausal Hormone Therapy Ann Intern Med, May 4, 2004; 140(9): 764 - 765. [Full Text] [PDF]
|
|
|
|
|
|
W. B. Kannel and D. Levy Menopause, Hormones, and Cardiovascular Vulnerability in Women Arch Intern Med, March 8, 2004; 164(5): 479 - 481. [Full Text] [PDF]
|
|
|
|
|
|
R. A. Lobo Evaluation of Cardiovascular Event Rates With Hormone Therapy in Healthy, Early Postmenopausal Women: Results From 2 Large Clinical Trials Arch Intern Med, March 8, 2004; 164(5): 482 - 484. [Full Text] [PDF]
|
|
|
|
|
|
A.-L. Eriksson, S. Skrtic, A. Niklason, L. M. Hulten, O. Wiklund, T. Hedner, and C. Ohlsson Association between the low activity genotype of catechol-O-methyltransferase and myocardial infarction in a hypertensive population Eur. Heart J., March 1, 2004; 25(5): 386 - 391. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Wakatsuki, N. Ikenoue, K. Shinohara, K. Watanabe, and T. Fukaya Effect of Lower Dosage of Oral Conjugated Equine Estrogen on Inflammatory Markers and Endothelial Function in Healthy Postmenopausal Women Arterioscler. Thromb. Vasc. Biol., March 1, 2004; 24(3): 571 - 576. [Abstract] [Full Text]
|
|
|
|
|
|
F. Grodstein, K. Lifford, N. M. Resnick, and G. C. Curhan Postmenopausal Hormone Therapy and Risk of Developing Urinary Incontinence Obstet. Gynecol., February 1, 2004; 103(2): 254 - 260. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Mericli, G. L. Nadasy, M. Szekeres, S. Varbiro, Z. Vajo, M. Matrai, N. Acs, E. Monos, and B. Szekacs Estrogen replacement therapy reverses changes in intramural coronary resistance arteries caused by female sex hormone depletion Cardiovasc Res, February 1, 2004; 61(2): 317 - 324. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. L. Hersh, M. L. Stefanick, and R. S. Stafford National Use of Postmenopausal Hormone Therapy: Annual Trends and Response to Recent Evidence JAMA, January 7, 2004; 291(1): 47 - 53. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Garbe and S. Suissa Issues to debate on the Women's Health Initiative (WHI) study: Hormone replacement therapy and acute coronary outcomes: methodological issues between randomized and observational studies Hum. Reprod., January 1, 2004; 19(1): 8 - 13. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. E.D. Chilvers, R. C. Knibb, S. J. Armstrong, K. L. Woods, and R. F.A. Logan Post menopausal hormone replacement therapy and risk of acute myocardial infarction -- a case control study of women in the East Midlands, UK Eur. Heart J., December 2, 2003; 24(24): 2197 - 2205. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. F. Col and S. G. Pauker The Discrepancy between Observational Studies and Randomized Trials of Menopausal Hormone Therapy: Did Expectations Shape Experience? Ann Intern Med, December 2, 2003; 139(11): 923 - 929. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. A. Fitzpatrick Hormones and the Heart: Controversies and Conundrums J. Clin. Endocrinol. Metab., December 1, 2003; 88(12): 5609 - 5610. [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Spence, T. Thornton, A. D. Muir, and N. D. Westcott The Effect of Flax Seed Cultivars with Differing Content of {alpha}-Linolenic Acid and Lignans on Responses to Mental Stress J. Am. Coll. Nutr., December 1, 2003; 22(6): 494 - 501. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Brett and C. A. Reuben Prevalence of Estrogen or Estrogen-Progestin Hormone Therapy Use Obstet. Gynecol., December 1, 2003; 102(6): 1240 - 1249. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Article
