HRT – it’s good for the heart

HRTThis article from the BMJ on the effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women was bought to my attention by a member who felt that its message was important for all of us to see, given recent safety concerns about HRT use.

1006 healthy, white women were selected. They were either recently (within 2 yrs) postmenopausal, or were peri-menopausal. They were aged 45 to 58. They were randomly allocated to either receiving HRT (cases), or not (controls). HRT used was triphasic, or oestradiol alone if they had no uterus. The composite ‘primary endpoint’ was death, admission to hospital for heart failure and MI. The study was stopped after 10 yrs because of safety concerns from other studies.

After 10 years, significantly fewer cases experienced the ‘primary endpoint’ than controls (hazard ratio 0.48, 3% cases vs 6.5% controls). This was not associated with a significant increase in any cancer, breast cancer, DVT nor stroke. At 16 years, there was still a reduction in the primary composite endpoint.

So, in conclusion, use of HRT for 10 years in healthy, white women who are recently menopausal or are peri-menopausal, is associated with less mortality, admission to hospital for heart failure and MI.

Remember (my advice!) that HRT is only licensed to use for symptoms of the menopause that adversely affect quality of life (eg vasomotor symptoms) and so you shouldn’t use it to try to reduce cardiovascular risk. It is nice to know that, if used correctly, it doesn’t seem to increase risk.

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton.

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