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HEART FAILURE

Hormone replacement therapy is associated with improved survival in women with advanced heart failure

JoAnn Lindenfeld, MD^*,*, Jalal K. Ghali, MD, Heidi J. Krause-Steinrauf, MS, Steven Khan, MD, Kirkwood Adams, Jr, MD^||, Steven Goldman, MD^¶, Mary Ann Peberdy, MD^#, Clyde Yancy, MD^**, Surai Thaneemit-Chen, MS, Rhonda L. Larsen, RN, James Young, MD, Brian Lowes, MD^*, Yves D. Rosenberg, MD BEST Investigators

^* University of Colorado Health Sciences Center and Center for Women’s Health Research, Denver, Colorado, USA
Cardiac Centers of Louisiana, Shreveport, Louisiana, USA
National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
Cedars-Sinai Medical Center, Los Angeles, California, USA
^|| University of North Carolina, Chapel Hill, North Carolina, USA
^¶ Tucson SAVAHCS, Tucson, Arizona, USA
^# Virginia Commonwealth University, Medical College of Virginia, Richmond, Virginia, USA
^** University of Texas Southwestern, Dallas, Texas, USA
VA Palo Alto Health Care System Cooperative Studies Program, Palo Alto, California, USA
Duke Clinical Research Institute, Durham, North Carolina, USA
Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received February 5, 2003; revised manuscript received April 9, 2003, accepted April 18, 2003.

^* Reprint requests and correspondence: Dr. JoAnn Lindenfeld, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, B-130, Denver, Colorado 80262, USA.
JoAnn.Lindenfeld{at}UCHSC.edu

OBJECTIVES: We sought to determine whether hormone replacement therapy (HRT) is associated with an improved prognosis in women with advanced heart failure (HF) and systolic dysfunction.

BACKGROUND: There are about two million postmenopausal women in the U.S. with HF. However, limited data are available to assess the effects of HRT on survival in this large group of patients.

METHODS: A retrospective analysis of women age 50 years and over entered into the Beta-Blocker Evaluation of Survival Trial (BEST) was conducted using Cox regression analysis comparing survival in HRT users and non-users after correcting for baseline variables known to predict survival in women with HF and systolic dysfunction.

RESULTS: In 493 women age 50 years and older, HRT was associated with a significant reduction in mortality—21% mortality in HRT users and 34% in non-users (p = 0.025). Multivariate analysis demonstrated a hazard ratio for mortality of 0.6 (95% confidence interval = 0.36 to 0.97) (p = 0.039) for HRT users. The benefits of HRT were noted only in women with a nonischemic etiology of HF (n = 237).

CONCLUSIONS: Hormone replacement therapy is associated with a marked improvement in survival in postmenopausal women with advanced HF. A prospective, randomized trial of HRT should be performed in this large group of patients.

Abbreviations and Acronyms   BMI = body mass index   CAD = coronary artery disease   CHF = congestive heart failure   CI = confidence interval   CTR = cardiothoracic ratio   HF = heart failure   HR = hazard ratio   HRT = hormone replacement therapy   LVEF = left ventricular ejection fraction   MAPK = mitogen-activated protein kinase   NYHA = New York Heart Association

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