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J Am Coll Cardiol, 2001; 38:1-7
© 2001 by the American College of Cardiology Foundation
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CLINICAL STUDY

Initiation of hormone replacement therapy after acute myocardial infarction is associated with more cardiac events during follow-up

Karen P. Alexander, MD, FACCa, L. Kristin Newby, MD, FACC{dagger}, Anne S. Hellkamp, MS{dagger}, Robert A. Harrington, MD, FACC{dagger}, Eric D. Peterson, MD, MPH, FACCa, Steve Kopecky, MD, FACC{ddagger}, Antoly Langer, MD, FACC§, Patrick O’Gara, MD, FACC||, Christopher M. O’Connor, MD, FACC{dagger}, Robert N. Daly, MS, PhD, Robert M. Califf, MD, FACC{dagger}, Steven Khan, MD, FACC# and Valentin Fuster, MD, FACC**

a Outcomes Research and Assessment Group, The Duke Clinical Research Institute, Durham, North Carolina, USA
{dagger} The Duke Clinical Research Institute, Durham, North Carolina, USA
{ddagger} Mayo Clinic, Rochester, Minnesota, USA
§ St. Michael’s Hospital, Toronto, Canada
|| Brigham and Women’s Hospital, Boston, Massachusetts, USA
Dupont Pharmaceuticals, Wilmington, Delaware, USA
# Cedars-Sinai Medical Center, Los Angeles, California, USA
** Mount Sinai Medical Center, New York, New York, USA

Manuscript received July 24, 2000; revised manuscript received February 2, 2001, accepted March 28, 2001.

Reprint requests and correspondence: Dr. Karen P. Alexander, Duke University Medical Center, Box 3411, Durham, North Carolina 27710
alexa019{at}mc.duke.edu

OBJECTIVES

This study explored the association between the initiation of hormone replacement therapy (HRT) and early cardiac events (<1 year) in women with a recent myocardial infarction (MI).

BACKGROUND

Observational studies have linked postmenopausal hormone use with a reduced risk of death from heart disease. However, a recent randomized trial of HRT found no long-term benefit, primarily due to an increase in cardiac events in the first year.

METHODS

The Coumadin Aspirin Reinfarction Study (CARS) database contains information on HRT use and menopausal status for women with a recent MI. We classified the 1,857 postmenopausal women in CARS as prior/current HRT users if they took HRT before enrollment, new users if they began HRT during the study period or never users. We assessed the incidence of cardiac events (death, MI, unstable angina [UA]) during follow-up.

RESULTS

In our cohort, 28% (n = 524) used HRT at some point. Of these, 21% (n = 111) began HRT after their MI. New users had a higher incidence of death/MI/UA (41% vs. 28%, p = 0.001) during follow-up than never users, largely due to a higher incidence of UA (39% vs. 20%, p = 0.001). After adjustment, new users still had a significantly higher risk of death/MI/UA than never users during follow-up (relative risk [RR] = 1.44 [1.05–1.99]). Prior/current users had no excess risk of the composite end point after adjustment. Users of estrogen/progestin had a lower incidence of death/MI/UA during follow-up than users of estrogen only (RR = 0.56 [0.37–0.85]).

CONCLUSIONS

Postmenopausal women who initiated HRT after a recent MI had an increased risk of cardiac events largely due to excess UA during follow-up.

Abbreviations and Acronyms
  BP = blood pressure
  CARS = Coumadin Aspirin Reinfarction Study
  CI = confidence interval
  ECG = electrocardiographic or electrocardiogram
  EF = ejection fraction
  ERA = Estrogen Replacement and Atherosclerosis trial
  HERS = Heart and Estrogen/progestin Replacement Study
  HRT = hormone replacement therapy
  MI = myocardial infarction
  PEPI = Postmenopausal Estrogen/Progestin Intervention trial
  PTCA = percutaneous transluminal coronary angioplasty
  PVD = peripheral vascular disease
  RR = relative risk
  TIA = transient ischemic attack
  UA = unstable angina




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Copyright © 2001 by the American College of Cardiology Foundation.