Postmenopausal hormone use in women with acute coronary syndromes.

Abstract

BACKGROUND:

Recent trials reveal no benefit and possible harm from chronic hormone replacement therapy (HRT). Less is known about intermediate-term outcomes associated with HRT use in the setting of acute coronary syndromes (ACS).

METHODS:

To examine the prevalence of HRT use and relationships with intermediate-term outcomes among women with ACS, we classified as HRT users or nonusers 4029 postmenopausal women (age > 50 years or postmenopausal by case report form) randomized in the Sibrafiban versus Aspirin to Yield Maximum Protection from Ischemic Heart Events Post-Acute Coronary Syndromes (SYMPHONY) and 2nd SYMPHONY trials. Outcomes included 90-day and 1-year death and 90-day stroke, death, or myocardial infarction (MI); death, MI, or stroke; and death, MI, or severe recurrent ischemia (SRI).

RESULTS:

HRT use was 13% overall and varied by region (Asia, 0%; Eastern Europe, 0.2%; Latin America, 0.8%; Western Europe, 4%; Australia/New Zealand, 12%; Canada, 14%; United States, 24%); estrogen-only regimens were most common (90%). HRT users were younger, had higher estimated creatinine clearance, more frequently were smokers and had prior revascularization, but less frequently had diabetes, prior angina, or heart failure. Unadjusted 90-day and 1-year mortality rates were lower among HRT users (hazard ratios [95% CI] 0.48 [0.23-0.98] and 0.35 [0.18-0.68], respectively) but after multivariable adjustment, were not significantly different. Ninety-day stroke and composite end points did not differ between HRT users and nonusers.

CONCLUSIONS:

HRT use (predominantly estrogen-only) was low among patients with ACS but varied by region and was not associated with improved intermediate-term outcomes. These results are consistent with the absence of benefit from HRT use (combination or estrogen only) in previous studies in more stable populations.

• Authors: Elizabeth Parsons, L Kristin Newby, Manjushri V Bhapkar, Karen P Alexander, Harvey D White, Svati H Shah, Cheryl D Bushnell, Robert M Califf, Symphony and 2nd Symphony Investigators
• Journal: Journal of women's health (2002) (J Womens Health (Larchmt)) Vol. 13 Issue 8 Pg. 863-71 (Oct 2004) ISSN: 1540-9996 [Print] United States
• PMID: 15671702 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Oximes
• Piperidines
• Platelet Aggregation Inhibitors
• Aspirin
• sibrafiban

Topics

• Aged
• Aspirin (therapeutic use)
• Attitude to Health
• Coronary Disease (epidemiology, etiology)
• Estrogen Replacement Therapy (adverse effects, statistics & numerical data)
• Female
• Global Health
• Humans
• Middle Aged
• Myocardial Infarction (epidemiology, etiology)
• Odds Ratio
• Oximes (therapeutic use)
• Piperidines (therapeutic use)
• Platelet Aggregation Inhibitors (therapeutic use)
• Postmenopause
• Prevalence
• Randomized Controlled Trials as Topic
• Surveys and Questionnaires
• Survival Analysis
• Time Factors
• Treatment Outcome
• Women's Health