Hormone therapy in women after heart transplantation

Hormone therapy (HT) for menopausal women has been controversial regarding cardiac outcomes and adverse effects. Studies suggest that HT may cause increase in heart disease, stroke, and cancer. The use of HT in heart transplantation has not been firmly established.

The records of 356 female heart transplant recipients, undergoing transplantation from 1994 to 2011, were reviewed. We found 19 patients after age 35 years who were initiated on HT for noncontraceptive purposes. These patients were compared 1:3 with a contemporaneous control group matched for age, sex, era, and time after heart transplantation (paired for time from transplantation to initiation of HT). We assessed for subsequent 5-year survival, freedom from cardiac allograft vasculopathy (CAV; stenosis ≥ 30%), freedom from nonfatal major adverse cardiac events (NF-MACE; myocardial infarction, heart failure, percutaneous cardiac intervention, stroke, and need for pacemaker/defibrillator), and subsequent 1-year freedom from any-treated rejection. Additionally, we compared significant adverse effects of HT between groups.

HT patients compared with control subjects revealed no significant difference in subsequent 5-year survival (79% vs 75%; P = .66), freedom from CAV (90% vs 88%; P = .85), or NF-MACE (90% vs 93%; P = .65). There was also no significant difference in subsequent 1-year freedom from any-treated rejection between the groups. Other adverse effects of HT including subsequent 5-year incidence of thrombosis (pulmonary embolus), malignancy, and stroke were also similar to control subjects.

HT is not associated with poor outcome or adverse effects in female heart transplant patients after age 35 years. However, a larger cohort of patients is necessary to confirm these observations.