Cardiovascular (CV) risk if stopped HRT

• data from the Woman's Health Initiative trial provides data as to the risks of cancer, cardiovascular disease and fractures following stopping HRT treatment
  • analysis of delayed and sustained health benefits and risks following randomized allocation to CEE (conjugated equine estrogens) plus MPA (medroxyprogesterone acetate) vs placebo adds new information to inform the optimal use of postmenopausal CEE plus MPA
  • during postintervention follow-up - mean 2.4 years of follow-up
    • the overall risk of cardiovascular events was comparable in those initially assigned to CEE plus MPA and to placebo
    • a greater risk of malignancies was observed in the CEE plus MPA compared with the placebo group
      • greater risk of malignancies occurred in the CEE plus MPA than in the placebo group
      • more breast cancers were diagnosed in women who had been randomly assigned to receive CEE plus MPA vs placebo
      • all-cause mortality was somewhat higher in the CEE plus MPA than in the placebo group (1.20% [n = 233] vs 1.06% [n = 196]; HR, 1.15; 95% CI, 0.95-1.39)
    • no differences in the risk of fractures by treatment group were seen
  • study authors state that following termination of use of CEE plus MPA of 3.5 to 8.5 years, clinical vigilance seems warranted with respect to a sustained higher risk of malignancies

Reference:

• 1. Heiss G et al. Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA. 2008 Mar 5;299(9):1036-4