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Published on 6 June 2007

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HRT risk: jury still out

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Despite recent studies on the cardiovascular effects of HRT, the level of risk of women in early menopause suffering coronary heart disease (CHD) remains controversial, according to BMJ Clinical Evidence.

In an editorial published today, BMJ Clinical Evidence reports that whilst observational studies have consistently found that postmenopausal HRT reduces the risks of CHD, the Women’s Health Initiative (WHI) study found contradictory results.

Now a study published in the Journal of the American Medical Association has taken a second look at the results from the WHI study, asking whether the cardiovascular risks of HRT differ with age and time after onset of menopause.

The findings of this second-look study are consistent with the initial conclusions from the WHI study, as the authors found HRT did not reduce the overall risk of CHD and did increase the risk of stroke. However, the authors also found that while women starting HRT in their 70s and more than 20 years after reaching menopause had an increased risk of CHD compared with non-users, this was not the case for women starting HRT in their 50s, or fewer than 10 years after the onset of menopause.

The authors of the JAMA study argue that the findings provide some reassurance for younger postmenopausal women about the risks of CHD while using HRT. But Dr Shannon Amoils, clinical editor of BMJ Clinical Evidence, commented that the number of cardiovascular events in the study subgroups was probably still too small to allow meaningful analysis.

She said: “Further high-quality research is needed on the long-term effects of HRT on women in early menopause to assess conclusively the cardiovascular risks and benefits of HRT”.

BMJ Group 6/6/2007



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