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Susan R. Heckbert, MD, PhD; Robert C. Kaplan, PhD; Noel S. Weiss, MD, DrPH; Bruce M. Psaty, MD, PhD; Danyu Lin, PhD; Curt D. Furberg, MD, PhD; Jacqueline R. Starr, MPH; Gail D. Anderson, PhD; Andrea Z. LaCroix, PhD

Arch Intern Med. 2001;161:1709-1713.

Background  The finding from the Heart and Estrogen/Progestin Replacement Study (HERS) of increased coronary risk restricted to the first year after starting postmenopausal hormone therapy raises new questions about the role of hormone therapy in women with coronary heart disease. We assessed the risk of recurrent myocardial infarction or coronary heart disease death associated with the use and recent initiation of hormone therapy in women who survived a first myocardial infarction.

Methods  The setting for this population-based inception cohort study was Group Health Cooperative, a health maintenance organization. We studied 981 postmenopausal women who survived to hospital discharge after their first myocardial infarction between July 1, 1986, and December 31, 1996. We obtained information on hormone use from the Group Health Cooperative computerized pharmacy database and identified recurrent coronary events by medical record review.

Results  During median follow-up of 3.5 years, there were 186 recurrent coronary events. There was no difference in the risk of recurrent coronary events between current users of hormone therapy and other women (adjusted relative hazard [RH], 0.96; 95% confidence interval [CI], 0.62-1.50). Relative to the risk in women not currently using hormones, there was a suggestion of increased risk during the first 60 days after starting hormone therapy (RH, 2.16; 95% CI, 0.94-4.95) and reduced risk with current hormone use for longer than 1 year (RH, 0.76; 95% CI, 0.42-1.36).

Conclusion  These results are consistent with the findings from the HERS, suggesting a transitory increase in coronary risk after starting hormone therapy in women with established coronary heart disease and a decreased risk thereafter.

From the Departments of Epidemiology (Drs Heckbert, Weiss, Psaty, and LaCroix and Ms Starr), Pharmacy (Drs Heckbert and Anderson), Medicine (Dr Psaty), Health Services (Dr Psaty), and Biostatistics (Dr Lin), Cardiovascular Health Research Unit, University of Washington, Seattle; the Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY (Dr Kaplan); the Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (Dr Furberg); and the Center for Health Studies, Group Health Cooperative, Seattle (Dr LaCroix).

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