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Risk of Recurrent Coronary Events in Relation to Use and Recent Initiation of Postmenopausal Hormone Therapy
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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