October 10th, 2012
Danish Study Gives a Boost to Hormone Replacement Therapy ‘Timing Hypothesis’
Hormone replacement therapy (HRT) suffered a sharp blow a decade ago when the Women’s Health Initiative failed to show any cardiovascular benefit in women taking HRT. Despite the setback, many researchers theorized that HRT might still be beneficial in women who start HRT close to menopause. Now a study from Denmark published in BMJ lends strong support to the “timing hypothesis.”
Louise Lind Schierbeck and colleagues analyzed data from 1006 recently postmenopausal or perimenopausal women who were randomized to HRT or no treatment.
After 10 years, there were 16 primary endpoint events (the composite of death, admission to the hospital for heart failure, or MI) in the HRT group compared with 33 in the control group (hazard ratio 0.48, CI 0.26-0.87, p=0.015).
- Mortality: 15 versus 26, HR 0.57, 0.30-1.08, p=0.084
- Heart failure: 1 versus 7, HR 0.14, 0.02-1.16, p=0.07
- MI: 1 versus 4, HR 0.25, 0.03-2.21, p=0.21.
There was no significant difference between the groups in the rate of any cancer or of breast cancer. Women who were under 50 years of age at the start of the trial appeared to enjoy the greatest benefit from HRT.
The authors concluded:
Our findings suggest that initiation of hormone replacement therapy in women early after menopause significantly reduces the risk of the combined endpoint of mortality, myocardial infarction, or heart failure. Importantly, early initiation and prolonged hormone replacement therapy did not result in an increased risk of breast cancer or stroke.
Andrew Kaunitz told Physician’s First Watch that, when “taken together with findings from a subanalysis of younger women from the WHI, these data should reassure clinicians and women that use of hormone therapy in recently menopausal women is safe.”