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Hormone replacement therapy and risk for coronary heart disease. Data from the CORA-study--a case-control study on
Eberhard Windler1, Birgit-Christiane Zyriax, Britta Eidenmüller
1Center of Internal Medicine, University Hospital Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany. Prof.Windler@t-online.de
Insights
Current hormone replacement therapy (HRT) use was associated with a lower risk of coronary artery disease in women. While HRT may offer cardiovascular benefits, intense smoking can counteract these positive effects.
Area of Science:
- Cardiovascular Disease Research
- Hormone Replacement Therapy Studies
- Women's Health
Background:
- Uncertainty exists regarding the cardiovascular benefits or harms of hormone replacement therapy (HRT).
- Previous intervention studies have yielded conflicting results on HRT's impact on cardiovascular disease prevention.
- This study addresses the need for clarity on HRT's role in cardiovascular health.
Purpose of the Study:
- To investigate the association between hormone replacement therapy (HRT) use and coronary heart disease (CHD).
- To compare risk factors and lifestyle characteristics in current HRT users versus never users.
- To determine the independent impact of HRT on CHD manifestation.
Main Methods:
- The Coronary Risk Factors for Atherosclerosis (CORA) study included 200 women with incident coronary heart disease and 255 age-matched controls.
- Data collected included clinical parameters, biochemical markers, and lifestyle information.
- Multivariate analysis was employed to assess the association between HRT use and CHD risk.
Main Results:
- Current HRT users had a significantly lower prevalence of CHD compared to never users (20.2% vs. 42.5%).
- Current HRT users exhibited healthier profiles, including lower BMI, waist-to-hip ratio, and reduced prevalence of hypertension, insulin resistance, and diabetes.
- Multivariate analysis revealed a 57% lower risk of coronary artery disease for current HRT users (OR 0.428).
Conclusions:
- Data suggest HRT may have beneficial effects on weight, adiposity, insulin sensitivity, and blood pressure.
- HRT use was not associated with an adverse impact on cardiovascular disease.
- Intense smoking can counteract potential beneficial effects of HRT in some women.
Background:
Hormone replacement therapy (HRT) has been suggested to prevent cardiovascular disease, while some intervention studies have shed doubt on this concept. Thus, uncertainty remains whether current HRT use is beneficial as to cardiovascular disease or may even be harmful.
Objectives:
This research investigates the association of hormone replacement therapy, risk factors and lifestyle characteristics with the manifestation of coronary heart disease in current HRT users versus never users.
Design:
The coronary risk factors for atherosclerosis in women study (CORA-study) provide clinical and biochemical parameters and data on lifestyle in 200 consecutive pre- and postmenopausal women with incident coronary heart disease compared to 255 age-matched population-based controls, of which 87.9% were postmenopausal.
Results:
Significantly more controls than cases used currently HRT for a median of 9.5 years (32.9% versus 20.2%), while 50.0% of cases and 42.5% of controls had never used HRT (p<0.02). Compared to women who never used HRT, current users ate less meat and sausage, had a significantly lower BMI and waist-to-hip ratio and a lower prevalence of hypertension, insulin resistance and diabetes. However, current users among cases were often smokers and smoked significantly more cigarettes than never users. In a multivariate analysis the risk of current HRT users for coronary artery disease was 57% lower than the risk of never users (odds ratio 0.428, CI 0.206-0.860, p<0.02). Adjustment for conventional and dietary risk factors revealed neither current HRT use, nor HRT use combined with smoking as independent risk factors.
Conclusions:
These data from the CORA-study are not compatible with an adverse impact of hormone replacement therapy on cardiovascular disease, rather support the notion of beneficial effects of HRT on weight, central adiposity, insulin sensitivity and blood pressure. Yet, the data do not support the presumption of a general healthy user effect in women on HRT either. Rather, in some women adverse lifestyle habits, especially intense smoking, appear to counteract possible beneficial effects of HRT.
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