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Lipid changes on hormone therapy and coronary heart disease events in the Heart and Estrogen/progestin Replacement

Michael G Shlipak1, Lily A Chaput, Eric Vittinghoff

  • 1General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, Calif 94121, USA. shlip@itsa.ucsf.edu

American Heart Journal
|November 5, 2003
PubMed

Insights

Hormone therapy did not reduce coronary heart disease (CHD) events in postmenopausal women. Lipid changes from hormone therapy were not predictive of CHD outcomes in women with existing heart disease.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Clinical Trials

Background:

  • Combination hormone therapy (HT) in the Heart and Estrogen/progestin Replacement Study (HERS) did not reduce coronary heart disease (CHD) events.
  • HT effectively altered lipid profiles by lowering low-density lipoprotein cholesterol (LDL-C) and raising high-density lipoprotein cholesterol (HDL-C).
  • Mechanisms linking lipid changes to CHD outcomes with HT in women with established CHD require investigation.

Purpose of the Study:

  • To examine the association between lipid level changes and CHD outcomes among postmenopausal women receiving HT in the HERS trial.
  • To determine if baseline lipid levels or changes in lipid levels predict CHD events in women on HT.

Main Methods:

  • Analysis of HERS participants: postmenopausal women with prior CHD, randomized to HT or placebo.
  • Follow-up averaged 4.1 years.
  • Multivariate proportional hazards models compared associations between baseline lipids, year-1 lipid changes, and CHD events in the HT group.

Main Results:

  • Baseline LDL-C and HDL-C levels independently predicted CHD events in women on HT.
  • First-year reductions in LDL-C showed a marginal association with CHD events.
  • Neither increases in HDL-C nor triglyceride levels were associated with CHD events.
  • Changes in lipid levels during the first year of HT were not predictive of CHD outcomes.

Conclusions:

  • Lipid level changes induced by hormone therapy do not predict coronary heart disease outcomes in women with pre-existing heart disease.
  • The findings suggest that the lack of CHD event reduction with HT in HERS is not explained by lipid level changes.
Abstract

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