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Hormone Therapy At Menopause Fails To Halt Heart Disease Progression

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More than a decade ago the Women's Health Study produced surprising and important results when it showed that broad use of hormone replacement therapy did not reduce cardiovascular risk in post-menopausal women. But the study also led to speculation  that hormone therapy  might be beneficial when delivered closer to the time of menopause. Now a study published in Annals of Internal Medicine shows that menopausal hormone therapy (MHT) may have some favorable effects on some cardiovascular risk factors but it does not reduce the progression of atherosclerosis.

In the study, called KEEPS (Kronos Early Estrogen Prevention Study), 727 menopausal women were randomized to placebo or one of two forms of low dose hormone therapy (oral conjugated equine estrogens or transdermal 17β- estradiol). After 4 years there was no difference between the groups in the primary endpoint of the study, which was the progression of atherosclerosis as measured by carotid artery intima–media thickness (CIMT). There was also no difference in the coronary artery calcium scores. Women in the equine estrogen group had improvements in their lipid profiles (decrease in LDL and increase in HDL) while women in the transdermal group had improved insulin sensitivity. There was no difference in the incidence of serious adverse events.

The investigators offered several explanations for the findings, including a study population at low risk for athersosclerosis, a relatively short study duration, and the use of low dose but not high dose estrogen. "To the extent that these imaging methods predict CVD events, our findings suggest that MHT neither is a risk nor is protective in the population studied," they wrote. The study was not powered to look at clinical events.

Andrew Kaunitz, a specialist in women's health and menopause at the University of Florida, said that although it still remains unclear what the long term effects of hormone therapy will be on cardiovascular events, the study "does not support using hormone therapy to prevent CVD events."