Summary
This article discusses the results of a study that compared the effect of hormone therapy on the incidence of heart failure (HF), and HF survival in postmenopausal women aged 50 to 79 years (∼81% white) who were participants in the Women's Health Initiative Hormone Therapy Trials.
- Hormone Therapy
- Heart Failure
Over the last 30 years, the incidence of heart failure (HF) has increased in women by about 10% [Levy D et al. N Engl J Med 2002; Roger VL et al. JAMA 2004], and although survival has improved in women, it has not done so to the same degree as in men [Barker WH et al. Circulation 2006]. Although some studies have suggested a beneficial effect on HF survival from hormone therapy [Lindenfeld J et al. J Am Coll Cardiol 2003; Reis SE et al. J Am Coll Cardiol 2000], others have not seen this relationship [Bibbins-Domingo K et al. Am J Cardiol 2005].
Liviu Klein, MD, MS, Northwestern University, Feinberg School of Medicine, Chicago, IL, presented the results of a study that compared the effect of hormone therapy on the incidence of HF and HF survival in postmenopausal women aged 50 to 79 years (∼81% white) who were participants in the Women's Health Initiative (WHI) Hormone Therapy Trials. Subjects in this study were randomly assigned to receive 0.625 mg daily of conjugated equine estrogen (CEE) alone, CEE + 2.5 mg daily of medroxyprogesterone acetate (MPA), or placebo (PBO). A total of 10,739 women with prior hysterectomy were randomized to CEE or PLC; 16,608 women with uterus were randomized to CEE+MPA or PLC.
Subjects were followed for a mean of 7.9 years. There were 331 incident HF events that met the combination of clinical (WHI) and standardized (Framingham) criteria for HF. The incidence of HF was low, as would be expected in this relatively healthy population. Hormone therapy had no effect on the incidence of HF. The risk of HF was not significantly different in the combined HT group compared with the PLC group (Figure 1) or between the two hormone therapy groups (Table 1). There were no significant differences based on age or hormone replacement status.
Heart Failure Incidence and Survival Rates.
Reproduced with permission by L. Klein, MD.
Risk of Heart Failure.
There were 61 cardiovascular (CV) deaths and 95 total deaths in women with incident HF and 339 CV deaths and 1307 total deaths in women with no HF. Hormone therapy had no effect on CV (HR, 0.97; 95% CI, 0.79 to 1.21) or all-cause mortality (HR, 0.91; 95% CI, 0.67 to 1.24), even after adjustment for interim myocardial infarction and ejection fraction status, age, race, smoking, alcohol, hypertension, systolic blood pressure, BMI, diabetes, and high cholesterol.
The editors would like to thank the many members of the American Heart Association presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.
- © 2009 MD Conference Express
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