Hormone replacement therapy for postmenopausal women: does it help or harm your heart?

Embargoed: 00.01 GMT: Tuesday 10th March 2015

Press contact:
Jo Anthony
M +44(0) 7582 726 634 janthony@cochrane.org or pressoffice@cochrane.org

Evelyn Martinez
Senior Publicist, Wiley
T +1 201 748 6358, E sciencenewsroom@wiley.com

New evidence published today in the Cochrane Library shows that hormone replacement therapy (HRT) does not protect post-menopausal women against cardiovascular disease, and may even cause an increased risk of stroke.

HRT, now more commonly known as hormone therapy, is widely used for controlling menopausal symptoms. It has also been used for the prevention of cardiovascular disease in post-menopausal women. This latest evidence looked at the effects of using hormone therapy for at least six months and involved more than 40,000 women across the world.

The length of time women were on treatment varied across the trials from seven months to just over 10 years.

Overall, the results showed no evidence that hormone therapy provides any protective effects against death from any cause, and specifically death from cardiovascular disease, non-fatal heart attacks or angina, either in healthy women or women with pre-existing heart disease. Instead the findings showed a small increased risk of stroke for post-menopausal women.

The authors also explored how much of an effect there was of starting HRT earlier. They found some evidence that women who started treatment within the first 10 years of their menopause, when menopausal symptoms are most common, seemed to have a small protection against death and heart attacks, and no increased risk of stroke. But even in this group, the risk of deep vein thrombosis (DVT) increased.

Author Dr Henry Boardman, from the Department of Cardiovascular Medicine at the University of Oxford, says the harms and benefits of hormone therapy varied according to the ages of the women when they started their treatment.

“The evidence we have provides some support for the so-called ‘Timing Hypothesis’, but we should bear in mind the size of this effect," Dr Boardman said. "When we looked at the results according to the age of women, or by how long since their menopause that they started treatment, we found that if 1000 women under 60 years old started hormone therapy we would expect six fewer deaths, eight fewer cases of heart disease, and five extra blood clots over about seven years, compared to 1000 similar women who did not start hormone therapy.”

Dr Boardman continued, "the findings of this Cochrane Review need to be carefully considered. This is a complicated health issue, where the same treatment offers benefits in some women, but harms in others."

Dr David Tovey, Editor in Chief of the Cochrane Library commented, “This review adds a few more pieces to a complicated jigsaw of evidence relating to the use of HRT to treat symptoms of the menopause. The main analysis that the authors did found no benefit, so we need to apply caution to the results from the subgroup analysis. However, if true, this apparent benefit in preventing heart disease in younger women should be considered alongside other possible benefits and emerging evidence of harms, including the risk of breast cancer, ovarian cancer, and DVT.”

The Cochrane Review’s author, Dr Henry Boardman, concludes, “Hormone therapy remains a valid treatment option for women who are significantly troubled by menopausal symptoms; however, the risks and benefits of such treatment vary according to age and medical history. Discussion with your GP is recommended when considering treatment.”

Editor’s notes:
Full citation:  Boardman HMP, Hartley L, Eisinga A, Main C, Roqué i Figuls M, Bonfill Cosp X, Gabriel Sanchez R, Knight B. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database of Systematic Reviews 2015, Issue 3 . Art. No.: CD002229. DOI: 10.1002/14651858.CD002229.pub4.

Media spokesperson:
For comment or interview, please contact: Dr Henry Boardman, from the Department of Cardiovascular Medicine at the University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU UK,   Tel: +44 (0)1865 572833. Email: Harry.Boardman@cochrane.nhs.uk, or Dr David Tovey, Editor in Chief of the Cochrane Library,  Cochrane, St Albans House, 57-59 Haymarket, London SW1Y 4QX UK, +44 (0)20 7183 7503. Email: dtovey@cochrane.org.


For further information, please contact:

Jo Anthony
Senior Media and Communications Officer, Cochrane
+44(0) 7582 726 634 janthony@cochrane.org or pressoffice@cochrane.org

About Cochrane
Cochrane is a global independent network of researchers, professionals, patients, carers, and people interested in health.
Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews.

Cochrane is a not-for profit organization with collaborators from more than 120 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognized as representing an international gold standard for high quality, trusted information.

Find out more at cochrane.org
Follow us on twitter @cochranecollab

If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: pressoffice@cochrane.org

About Wiley
Wiley is a global provider of knowledge and knowledge-enabled services that improve outcomes in areas of research, professional practice, and education. Through the Research segment, the Company provides digital and print scientific, technical, medical, and scholarly journals, reference works, books, database services, and advertising. The Professional Development segment provides digital and print books, online assessment and training services, and test prep and certification. In Education, Wiley provides education solutions including online program management services for higher education institutions and course management tools for instructors and students, as well as print and digital content. The Company's website can be accessed at http://www.wiley.com.

Tuesday, March 10, 2015