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Hormone Replacement Therapy and Risk of Acute Myocardial Infarction

A Review of the Literatures

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Abstract

Many animal studies and studies on intermediate clinical endpoints have shown hormone replacement therapy (HRT) to be associated with both favourable and unfavourable cardiovascular effects. We reviewed the literature regarding HRT and the distinct endpoint of acute myocardial infarction (AMI) in peri- and postmenopausal women.

Searches of the MEDLINE and EMBASE databases were conducted. Fifty papers were identified as eligible for inclusion: eight randomised controlled trials, 18 cohort studies, 23 case-control studies and one case-control and cohort study.

The single large primary prevention randomised controlled trial on HRT and the risk of AMI in generally healthy women (Women’s Health Initiative trial) reported a small yet significantly increased risk of AMI in postmenopausal women receiving combined HRT. This contrasts with a large number of observational studies that suggested a protective effect, although in many of these studies the results were not statistically significant. Inconclusive evidence on the effect of duration of use does not support the notion that a possible protective association is causal. Detection bias and residual confounding are alternative explanations for the associations observed in the randomised controlled trial and observational studies. No studies on groups of women with existing cardiovascular disease or with diabetes mellitus, including the only large secondary prevention trial (Heart and Estrogen/Progestin Replacement Study), reported a significant change in AMI risk between HRT users and non-users.

There is insufficient evidence to suggest that HRT is associated with a change in the risk of AMI in the majority of women. However, certain subgroups of women with specific genetic polymorphisms may be more susceptible to a change in the risk of AMI with HRT use.

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Acknowledgements

This study was conducted at the University of Surrey and funded through an unconditional grant from Organon NV, The Netherlands. At the time the study was conducted, all authors were employed by the University of Surrey. The authors have no conflicts of interest that are directly relevant to the content of this study.

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  1. Department of Pharmacoepidemiology, Postgraduate Medical School (E5), University of Surrey, Stirling House, Stirling Road, Guildford, GU2 7DJ, UK

    Susan E. Bromley,  Corinne S. de Vries, Dawn Thomas & Richard D.T. Farmer

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  1. Susan E. Bromley
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  2. Corinne S. de Vries
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  3. Dawn Thomas
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Correspondence to Corinne S. de Vries.

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Bromley, S.E., de Vries, C.S., Thomas, D. et al. Hormone Replacement Therapy and Risk of Acute Myocardial Infarction. Drug-Safety 28, 473–493 (2005). https://doi.org/10.2165/00002018-200528060-00002

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