Postmenopausal hormone use in women with acute coronary syndromes.

Published

Journal Article

BACKGROUND: Recent trials reveal no benefit and possible harm from chronic hormone replacement therapy (HRT). Less is known about intermediate-term outcomes associated with HRT use in the setting of acute coronary syndromes (ACS). METHODS: To examine the prevalence of HRT use and relationships with intermediate-term outcomes among women with ACS, we classified as HRT users or nonusers 4029 postmenopausal women (age > 50 years or postmenopausal by case report form) randomized in the Sibrafiban versus Aspirin to Yield Maximum Protection from Ischemic Heart Events Post-Acute Coronary Syndromes (SYMPHONY) and 2nd SYMPHONY trials. Outcomes included 90-day and 1-year death and 90-day stroke, death, or myocardial infarction (MI); death, MI, or stroke; and death, MI, or severe recurrent ischemia (SRI). RESULTS: HRT use was 13% overall and varied by region (Asia, 0%; Eastern Europe, 0.2%; Latin America, 0.8%; Western Europe, 4%; Australia/New Zealand, 12%; Canada, 14%; United States, 24%); estrogen-only regimens were most common (90%). HRT users were younger, had higher estimated creatinine clearance, more frequently were smokers and had prior revascularization, but less frequently had diabetes, prior angina, or heart failure. Unadjusted 90-day and 1-year mortality rates were lower among HRT users (hazard ratios [95% CI] 0.48 [0.23-0.98] and 0.35 [0.18-0.68], respectively) but after multivariable adjustment, were not significantly different. Ninety-day stroke and composite end points did not differ between HRT users and nonusers. CONCLUSIONS: HRT use (predominantly estrogen-only) was low among patients with ACS but varied by region and was not associated with improved intermediate-term outcomes. These results are consistent with the absence of benefit from HRT use (combination or estrogen only) in previous studies in more stable populations.

Full Text

Duke Authors

Cited Authors

  • Parsons, E; Newby, LK; Bhapkar, MV; Alexander, KP; White, HD; Shah, SH; Bushnell, CD; Califf, RM; Symphony and 2nd Symphony Investigators,

Published Date

  • October 2004

Published In

Volume / Issue

  • 13 / 8

Start / End Page

  • 863 - 871

PubMed ID

  • 15671702

Pubmed Central ID

  • 15671702

Electronic International Standard Serial Number (EISSN)

  • 1931-843X

International Standard Serial Number (ISSN)

  • 1540-9996

Digital Object Identifier (DOI)

  • 10.1089/jwh.2004.13.863

Language

  • eng