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 ,
Anne S. Hellkamp, MS,
Robert A. Harrington, MD, FACC,
Eric D. Peterson, MD, MPH, FACCa,
Steve Kopecky, MD, FACC ,
Antoly Langer, MD, FACC ,
Patrick O’Gara, MD, FACC||,
Christopher M. O’Connor, MD, FACC,
Robert N. Daly, MS, PhD¶,
Robert M. Califf, MD, FACC,
Steven Khan, MD, FACC# and
Valentin Fuster, MD, FACC**
a Outcomes Research and Assessment Group, The Duke Clinical Research Institute, Durham, North Carolina, USA
The Duke Clinical Research Institute, Durham, North Carolina, USA
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 |
|
This article has been cited by other articles:
|
|
|
|
 
H. Okura, Y. Takada, A. Yamabe, T. Kubo, K. Asawa, T. Ozaki, H. Yamagishi, I. Toda, M. Yoshiyama, J. Yoshikawa, et al.
Age- and Gender-Specific Changes in the Left Ventricular Relaxation: A Doppler Echocardiographic Study in Healthy Individuals
Circ Cardiovasc Imaging,
January 1, 2009;
2(1):
41 - 46.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. L. Lujan, V. J. Kramer, and S. E. DiCarlo
Sex influences the susceptibility to reperfusion-induced sustained ventricular tachycardia and beta-adrenergic receptor blockade in conscious rats
Am J Physiol Heart Circ Physiol,
November 1, 2007;
293(5):
H2799 - H2808.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. E. Rossouw, R. L. Prentice, J. E. Manson, L. Wu, D. Barad, V. M. Barnabei, M. Ko, A. Z. LaCroix, K. L. Margolis, and M. L. Stefanick
Postmenopausal Hormone Therapy and Risk of Cardiovascular Disease by Age and Years Since Menopause
JAMA,
April 4, 2007;
297(13):
1465 - 1477.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. E. Lonning, J. Geisler, L. E. Krag, B. Erikstein, Y. Bremnes, A. I. Hagen, E. Schlichting, E. A. Lien, E. S. Ofjord, J. Paolini, et al.
Effects of Exemestane Administered for 2 Years Versus Placebo on Bone Mineral Density, Bone Biomarkers, and Plasma Lipids in Patients With Surgically Resected Early Breast Cancer
J. Clin. Oncol.,
August 1, 2005;
23(22):
5126 - 5137.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Ertl and S. Frantz
Healing after myocardial infarction
Cardiovasc Res,
April 1, 2005;
66(1):
22 - 32.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Voci, F. Pizzuto, and F. Romeo
Coronary flow: a new asset for the echo lab?
Eur. Heart J.,
November 1, 2004;
25(21):
1867 - 1879.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. K. Koh and I. Sakuma
Should Progestins Be Blamed for the Failure of Hormone Replacement Therapy to Reduce Cardiovascular Events in Randomized Controlled Trials?
Arterioscler. Thromb. Vasc. Biol.,
July 1, 2004;
24(7):
1171 - 1179.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Armstrong, J. S. Schwartz, T. Randall, S. C. Rubin, and B. Weber
Hormone Replacement Therapy and Life Expectancy After Prophylactic Oophorectomy in Women With BRCA1/2 Mutations: A Decision Analysis
J. Clin. Oncol.,
March 15, 2004;
22(6):
1045 - 1054.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. E van der Elst, H. Buurma, M. L Bouvy, and A. de Boer
Drug Therapy for Prevention of Recurrent Myocardial Infarction
Ann. Pharmacother.,
October 1, 2003;
37(10):
1465 - 1477.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Petersen, M. Grind, J. Adler, and SPORTIF II Investigators
Ximelagatran versus warfarin forstroke prevention in patientswith nonvalvular atrial fibrillation: SPORTIF ii: a dose-guiding, tolerability, and safety study
J. Am. Coll. Cardiol.,
May 7, 2003;
41(9):
1445 - 1451.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. H. Stone
Update in Cardiology
Ann Intern Med,
March 18, 2003;
138(6):
482 - 487.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Filippatos and J. T. Parissis
Estrogen administration in patients with chronic heart failure: not ready for prime time
Eur J Heart Fail,
March 1, 2003;
5(2):
113 - 116.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Schattner and R.H. Fletcher
Research evidence and the individual patient
QJM,
January 1, 2003;
96(1):
1 - 5.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. D. Shanafelt, D. L. Barton, A. A. Adjei, and C. L. Loprinzi
Pathophysiology and Treatment of Hot Flashes
Mayo Clin. Proc.,
November 1, 2002;
77(11):
1207 - 1218.
[Abstract]
[PDF]
|
|
|
|
|
|
|
L. L. Humphrey, B. K.S. Chan, and H. C. Sox
Postmenopausal Hormone Replacement Therapy and the Primary Prevention of Cardiovascular Disease
Ann Intern Med,
August 20, 2002;
137(4):
273 - 284.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Mullick, J. M. McDonald, G. Melkonian, P. Talbot, K. E. Pinkerton, and J. C. Rutledge
Reactive carbonyls from tobacco smoke increase arterial endothelial layer injury
Am J Physiol Heart Circ Physiol,
August 1, 2002;
283(2):
H591 - H597.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Group for the Women's Health Initiative In
Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women's Health Initiative Randomized Controlled Trial
JAMA,
July 17, 2002;
288(3):
321 - 333.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. W. Fletcher and G. A. Colditz
Failure of Estrogen Plus Progestin Therapy for Prevention
JAMA,
July 17, 2002;
288(3):
366 - 368.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Grady, D. Herrington, V. Bittner, R. Blumenthal, M. Davidson, M. Hlatky, J. Hsia, S. Hulley, A. Herd, S. Khan, et al.
Cardiovascular Disease Outcomes During 6.8 Years of Hormone Therapy: Heart and Estrogen/Progestin Replacement Study Follow-up (HERS II)
JAMA,
July 3, 2002;
288(1):
49 - 57.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Barrett-Connor, D. Grady, A. Sashegyi, P. W. Anderson, D. A. Cox, K. Hoszowski, P. Rautaharju, K. D. Harper, and for the MORE Investigators
Raloxifene and Cardiovascular Events in Osteoporotic Postmenopausal Women: Four-Year Results From the MORE (Multiple Outcomes of Raloxifene Evaluation) Randomized Trial
JAMA,
February 20, 2002;
287(7):
847 - 857.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. E Rossouw
Hormones, genetic factors, and gender differences in cardiovascular disease
Cardiovasc Res,
February 15, 2002;
53(3):
550 - 557.
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. A Babiker, L. J De Windt, M. van Eickels, C. Grohe, R. Meyer, and P. A Doevendans
Estrogenic hormone action in the heart: regulatory network and function
Cardiovasc Res,
February 15, 2002;
53(3):
709 - 719.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. D. Waters
Estrogen therapy for unstable angina: Another bump for the bandwagon
J. Am. Coll. Cardiol.,
January 16, 2002;
39(2):
238 - 240.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Voci and F. Pizzuto
Coronary flow: how far can we go with echocardiography?
J. Am. Coll. Cardiol.,
December 1, 2001;
38(7):
1885 - 1887.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. G. Shlipak, B. G. Angeja, A. S. Go, P. D. Frederick, J. G. Canto, and D. Grady
Hormone Therapy and In-Hospital Survival After Myocardial Infarction in Postmenopausal Women
Circulation,
November 6, 2001;
104(19):
2300 - 2304.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Starting Hormone Therapy After MI Increases Risk for Cardiac Events
Journal Watch Women's Health,
September 18, 2001;
2001(918):
1 - 1.
[Full Text]
|
|
|
|
|
|
|
Hormone Replacement Therapy for Coronary Artery Disease?
Journal Watch (General),
August 3, 2001;
2001(803):
5 - 5.
[Full Text]
|
|
|
|
|
|
|
D. Grady and S. B. Hulley
Postmenopausal hormones and heart disease
J. Am. Coll. Cardiol.,
July 1, 2001;
38(1):
8 - 10.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. K. Koh, W. H. Schenke, M. A. Waclawiw, G. Csako, and R. O. Cannon III
Statin Attenuates Increase in C-Reactive Protein During Estrogen Replacement Therapy in Postmenopausal Women
Circulation,
April 2, 2002;
105(13):
1531 - 1533.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
