Postmenopausal Hormone Replacement Therapy and the Primary Prevention of Cardiovascular Disease
- Linda L. Humphrey, MD, MPH;
- Benjamin K.S. Chan, MS; and
- Harold C. Sox, MD, Editor
- From Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon; and American College of Physicians-American Society of Internal Medicine, Philadelphia, Pennsylvania.
Abstract
Purpose: To evaluate the value of hormone replacement therapy (HRT) in the primary prevention of cardiovascular disease (CVD) and coronary artery disease (CAD).
Data Sources: MEDLINE and Cochrane databases were searched for all primary prevention studies reporting CVD or CAD incidence, mortality, or both in association with HRT; reference lists, letters, editorials, and reviews were also reviewed.
Data Extraction: All studies were reviewed, abstracted, and rated for quality.
Study Selection: Only studies of good or fair quality, according to U.S. Preventive Services Task Force (USPSTF) criteria, were included in the detailed review and meta-analysis.
Data Synthesis: The summary relative risk with any HRT use was 0.75 (95% credible interval [CrI], 0.42 to 1.23) for CVD mortality and 0.74 (CrI, 0.36 to 1.45) for CAD mortality. The summary relative risk with any use was 1.28 (CrI, 0.86 to 2.00) for CVD incidence and 0.87 (CrI, 0.62 to 1.21) for CAD incidence. Further analysis of studies adjusting for socioeconomic status, as well as other major CAD risk factors, showed a summary relative risk of 1.07 (CrI, 0.79 to 1.48) for CAD incidence associated with any HRT use. Similar results were found when the analysis was stratified by studies adjusting for alcohol consumption, exercise, or both, in addition to other major risk factors, suggesting confounding by these factors.
Conclusions: This meta-analysis differs from previous meta-analyses by evaluating potential explanatory variables of the relationship between HRT, CVD, and CAD. The adjusted meta-analysis is consistent with recent randomized trials that have shown no benefit in the secondary or primary prevention of CVD events. A valid answer to the role of HRT in the primary prevention of CVD will best come from randomized, controlled trials.
Article and Author Information
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Note: This manuscript is based on a longer systematic evidence review that was reviewed by outside experts and representatives of professional societies. A complete list of peer reviewers is available in the complete report, which can be accessed online at http://www.ahrq.gov/clinic/uspstfix.htm.
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Disclaimer: Review of this material does not imply agreement with or endorsement of the conclusions of this article, which are solely those of the authors. No statement in this article should be construed as official policy of the Agency for Healthcare Research and Quality.
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As a coauthor, Dr. Sox did not participate in the review process or in the decision to accept the manuscript for publication.
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Acknowledgments: The authors thank Steven Teutsch, MD, MPH; Janet Allan, PhD, RN; and David Atkins, MD, MPH, from the U.S. Preventive Services Task Force and Mark Helfand, MD, MS; Heidi Nelson, MD, MPH; and Gary Miranda, MA, from the Oregon Health & Science University Evidence-based Practice Center for their helpful comments on earlier versions of this review. They also thank Susan Wingenfeld and Jim Wallace for assistance in manuscript preparation.
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Grant Support: This study was conducted by the Oregon Health & Science University Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (contract no. 290-97-0018, task order no. 2), Rockville, Maryland.
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Requests for Single Reprints: Reprints are available from the AHRQ Web site at http://www.preventiveservices.ahrq.gov and in print through the AHRQ Publications Clearinghouse.
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Current Author Addresses: Dr. Humphrey and Mr. Chan: Oregon Health & Science University, Mail Code BICC 504, 3181 SW Sam Jackson Park Road, Portland, OR 97201.
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Dr. Sox: American College of Physicians-American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106.
- Copyright ©2004 by the American College of Physicians
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