Hot flushes, coronary heart disease, and hormone therapy in postmenopausal women

Area of Science:

• Cardiovascular Health
• Menopause Research
• Hormone Therapy Studies

Background:

• Coronary heart disease (CHD) is a significant concern for postmenopausal women.
• Estrogen plus progestogen therapy (EPT) is used for menopausal symptoms but has potential cardiovascular risks.
• Interactions between menopausal symptoms, hormone therapy, and cardiovascular events require further investigation.

Purpose of the Study:

• To investigate the relationship between hot flushes, EPT use, and the occurrence of CHD events in postmenopausal women with pre-existing CHD.
• To determine if the presence and severity of hot flushes modify the cardiovascular risk associated with EPT.

Main Methods:

• Analysis of data from the Heart and Estrogen/Progestin Replacement Study, a randomized, placebo-controlled trial.
• Inclusion of 2,763 postmenopausal women diagnosed with CHD.
• Assessment of baseline hot flushes using questionnaires and analysis of CHD events using Cox regression models, stratified by flushing status.

Main Results:

• Sixteen percent of participants reported clinically significant hot flushes at baseline.
• Among women with significant hot flushes, EPT use was associated with a nine-fold increased risk of CHD events in the first year (HR=9.01).
• No significant increase in CHD event risk was observed with EPT use in the first year for women without baseline hot flushes (HR=1.32).

Conclusions:

• In older postmenopausal women with CHD, EPT may substantially increase the risk of CHD events within the first year of treatment, particularly in those experiencing significant hot flushes.
• The heightened risk observed in the first year among women with hot flushes did not persist beyond this initial period.
• Findings suggest a potential interaction between EPT, hot flushes, and short-term cardiovascular risk in this population.