Individualizing Hormone Therapy to Minimize Risk

Accurate Assessment of Risks and Benefits

Donna Shoupe

Disclosures

Women's Health. 2011;7(4):475-485. 

In This Article

Reduced Mortality

Misconceptions still exist that cardiovascular disease is not a real problem for women, although it is estimated that one in two women will eventually die of heart disease or stroke, compared with one in 25 who will eventually die of breast cancer. Cardiovascular disease, particularly CHD and stroke, remains the leading killer of women in the USA and most developed countries.[46,47] Evidence suggests that postmenopausal women on hormone therapy, if started within the therapeutic window, have a lowered mortality. This is largely thought to be due to estrogen's cardiovascular protection.

A 10 year follow-up of the Nurses' Health Study including 48,470 postmenopausal women, reported that the age-adjusted relative risk of mortality form all causes in women who used estrogen at any time was 0.81. For cardiovascular mortality it was 0.68. After adjustment for other risk factors, the relative risks remained significant. The age-adjusted relative risk for cardiovascular mortality was 0.52 for current estrogen users and 0.77 for former users.[102]

In a study utilizing data from 30 trials with 26,708 participants, hormone therapy significantly reduced mortality in the younger age group (OR: 0.61; 95% CI: 0.39–0.95) (Table 2).[37] A secondary analysis of the WHI was performed to determine whether the effects of hormone therapy on the risk of cardiovascular disease and mortality vary by age or years since menopause. There was a nonsignificant tendency for the effects of hormone therapy on total mortality to be more favorable in younger compared with older women in both the estrogen only and estrogen plus progestin trial. However, if both studies are combined, there is a significant trend towards a reduced mortality in younger versus older women; p-value for trend = 0.2 (Table 1).[25]

Table 3 shows a comparison of overall mortality rate with HRT in younger versus older postmenopausal women.[37]Table 4 is a comparison of the overall mortality rates in first decade menopausal women with HRT compared with lipid-lowering medication and aspirin.[26,32,37,48,49] Hormone therapy has the only statistically significant reduction in mortality for younger postmenopausal women.

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