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Hormone replacement therapy, heart disease, and other considerations
1Department of Family and Preventive Medicine, University of California, San Diego, La Jolla 92093-0607, USA. ebarrettconnor@ucsd.edu
Annual Review of Public Health
|June 5, 1998
Summary
Observational studies suggest hormone replacement therapy may reduce coronary heart disease (CHD) risk in postmenopausal women. However, risks of cancer and blood clots mean it shouldn't be widely recommended until randomized trials confirm benefits.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Oncology
Background:
- Observational studies indicate reduced coronary heart disease (CHD) risk with postmenopausal estrogen therapy.
- Estrogen's potential cardioprotective mechanisms are biologically plausible.
Purpose of the Study:
- To evaluate the association between estrogen plus progestin regimens and CHD risk in postmenopausal women.
- To synthesize evidence from observational studies regarding hormone therapy and cardiovascular outcomes.
Main Methods:
- Meta-analysis of observational studies examining estrogen and estrogen plus progestin use.
- Assessment of potential biases that may influence the observed associations.
Main Results:
- The meta-analysis extended findings of reduced CHD risk to estrogen plus progestin regimens.
- Acknowledged biases in observational studies likely exaggerate the benefits of estrogen therapy.
- Identified increased risks for endometrial hyperplasia/cancer, venous thromboembolism, and gallbladder disease associated with estrogen therapy.
Conclusions:
- Estrogen therapy increases risks for endometrial, thromboembolic, and gallbladder diseases.
- Long-term estrogen use may elevate breast cancer risk.
- Estrogen therapy should not be broadly recommended for CHD prevention in all postmenopausal women pending randomized trial data.