Hormone Replacement Therapy: The Cardio-protective Effect Is Not An Indication

In observational studies, morbidity and mortality from cardio-vascular (particularly coronary) were reduced in women who took estrogen (whether or not associated with progestin) for replacement therapy after menopause. As against, randomized studies on secondary prevention of coronary heart disease (coronary lesions background) with conjugated estrogens and medroxy progesterone acetate did not confirm a protective effect of estrogens. In addition, treatment was associated with an increased incidence of accidents thrombo-embolic and affections of the gallbladder. The introduction of a therapeutic substitution by estrogen is not indicated in the presence of pre-existing coronary lesions. Pending the results of randomized trials in primary prevention (no pre-existing coronary disease), prevention of coronary heart disease is not an indication.

Recently published were the results of the first randomized study on the cardio-protective effect of hormone replacement therapy in postmenopausal women in good health, ie in primary prevention (the study "Women's Health Initiative "). In this study, 16,608 women (aged 50 to 79 years) received

* either placebo
* an association of conjugated estrogens (0.625 mg pd) and medroxy progesterone acetate (2.5 mg pd).

The primary evaluation criteria were coronary heart disease (i.e. myocardial infarction and non-fatal cardiac death) and invasive breast cancer.

On 31 May 2002, the National Heart, Lung and Blood Institute in the United States has decided to prematurely stop the study among women not hysterectomies. The main reason for this decision was the finding after a follow-up of 5.2 years on average, an increased risk of invasive breast cancer in the group of hormone replacement compared to the placebo group it was calculated that for 10,000 women in this type of hormone replacement, 8 additional cases of breast cancer are diagnosed each year. An increased risk of coronary heart disease was also observed in the group of hormone replacement, especially during the first year of treatment: 7 additional cases of coronary heart disease per 10,000 women per year. For some secondary endpoints, in particular stroke and pulmonary embolism, increased risk was observed. The risk of colorectal cancer and fractures was lower against the group in hormone replacement. The total mortality in both groups was comparable.

This study does not draw conclusions on other forms of hormone replacement therapy, but according to the authors of the editorial, it is unlikely that different results obtained with other schemes. It should be noted however that these results could not be extrapolated to women who, due to a hysterectomy, take only estrogen: the study "Women's Health Initiative among women has not been interrupted so far.