Myocardial infarction hormone replacement

Psaty, B.M., N.L. Smith, R.N. Lemaitre, H.L. Vos, S.R. Heckbert, A.Z. LaCroix, and F.R. Rosendaal, Hormone replacement therapy, prothrombotic mutations, and the risk of incident nonfatal myocardial infarction in postmenopausal women. Jama, 2001.285(7) 906-13. 

Steiner MK, Clarkson PB, Lip GY. Myocardial infarction complicating hormone replacement therapy in a young woman with normal coronary arteries. Int J Clin Pract 2000 54(7) 475-7. 

Alexander KP, Newby LK, Hellkamp AS, Harrington RA, Peterson ED, Kopecky S, Langer A, O Gara P, O Connor CM, Daly RN, Califf RM, Khan S, Fuster V. Initiation of hormone replacement therapy after acute myocardial infarction is associated with more cardiac events during follow-up. J Am Coll Cardiol 2001 38(l) l-7. 

Conversely, an open randomised study analysed the effects of hormone replacement therapy (HRT) on cardiovascular episodes in 1006 women, aged 45-58years, whose treatment began early after their menopause [9 -]. A total of 502 women took HRT (17-p-oestradiol plus norethisterone acetate) and 504 placebo. Women were followed up for 16 years. The primary end point was the combination of death, heart failure or myocardial infarction. Sixteen women in the HRT group developed the primary composite end point compared with 33 controls (HR=0.48 95% Cl=0.26, 0.87). Reduction in cardiovascular events was not associated with an increase in any cancer (HR=0.92 95% CI=0.58, 1.45) or breast cancer (HR=0.58 95% Cl=0.27,1.27). After 16years, the reduction in the primary combined outcome was still present, and still no association with any cancer was observed. All these data suggest that HRT started early after menopause significantly reduces the risk of the combined end point of mortality, myocardial infarction or heart failure, while it did not increase the risk of breast cancer or strokes [9 ]. 

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