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

Alison J Huang1, George F Sawaya2,3, Eric Vittinghoff3

  • 1Departments of Medicine.

Menopause (New York, N.Y.)
|October 26, 2018
PubMed

Insights

Estrogen plus progestogen therapy (EPT) may significantly increase coronary heart disease (CHD) event risk in postmenopausal women with CHD and hot flushes during the first year of treatment. This risk was not observed in women without significant hot flushes.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Women's Health

Background:

  • Postmenopausal hormone therapy, including estrogen plus progestogen therapy (EPT), is used for symptom management.
  • The relationship between EPT, menopausal symptoms like hot flushes, and cardiovascular outcomes requires further investigation.
  • Coronary heart disease (CHD) is a significant concern for postmenopausal women.

Purpose of the Study:

  • To investigate the interaction between hot flushes, EPT, and the risk of coronary heart disease (CHD) events in postmenopausal women with 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 with CHD, assessing hot flushes at baseline.
  • Utilizing Cox regression models to evaluate EPT's effect on CHD events based on baseline hot flush status.

Main Results:

  • Sixteen percent of participants reported clinically significant hot flushes at baseline.
  • Among women with significant hot flushes, EPT was associated with a nine-fold increase in CHD event risk in the first year (HR=9.01).
  • Women without significant hot flushes did not show a significant increase in CHD event risk with EPT in the first year (HR=1.32).

Conclusions:

  • In postmenopausal women with CHD, EPT may substantially increase CHD event risk within the first year, particularly for those experiencing significant hot flushes.
  • The heightened risk observed in the first year did not persist beyond this initial period.
  • These findings suggest a potential differential effect of EPT on cardiovascular risk based on the presence of menopausal symptoms.
Abstract

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