Hormone replacement therapy and secondary cardiovascular prevention: A meta-analysis of randomized trials

Background: Coronary artery disease is the leading cause of death in women. Several randomized clinical trials of hormone replacement therapy ( HRT) in women with and without coronary artery disease have found no benefit of HRT in decreasing cardiovascular events. The purpose of this study was to assess the benefits and risks of HRT for prevention of cardiovascular events by conducting a meta- analysis of all randomized trials of HRT, and estimate cardiovascular event rates. Methods and Results: All relevant randomized, clinical trials were identified in MEDLINE ( 1966 - 2001), HealthSTAR ( 1975 2001), and Cochrane Library databases. The search terms were hormone replacement or HRT, estrogen, progesterone, women and heart disease. We used all published data of randomized, clinical trials of HRT if they reported cardiovascular endpoints. Meta- analysis of the randomized, clinical trials involving 21,066 patients revealed that HRT did not reduce mortality compared with control group ( 1.9 vs. 1.9%, odds ratio 1.05, 95% CI 0.86 - 1.30, p = 0.58) or significantly reduce risk of myocardial infarction ( 3.7 vs. 3.7%, odds ratio 1.04, 95% CI 0.90 - 1.21, p = 0.58) or revascularization ( 6.4 vs. 6.8%, odds ratio 0.95,95% CI 0.85 - 1.08, p = 0.50). The rate of acute coronary syndrome rate was 9.1% in the HRT group vs. 9.3% with odds ratio 1.00, 95% CI 0.90 - 1.12, p = 0.98. Conclusion: HRT use is not associated with reduced death, myocardial infarction or revascularization rate. This suggests that HRT is not an effective secondary cardiovascular preventive measure.