#88 Hormone Therapy: Does Timing Make a Difference?
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- Statistically significant reduction in composite outcome (death, hospitalization for heart failure, and myocardial infarction) in HT users
- Hazard ratio (HR) 0.48 (0.26-0.87)
- Limitations: Secondary analysis of an osteoporosis study with this outcome defined post-hoc; open-label design; included estrogen-only group; low event rate.
- Combination HT within 10 years of menopause had non-statistically significant:
- Reduced coronary heart disease (CHD): HR 0.88 (0.54-1.43)
- Increased stroke: HR 1.58 (0.81-3.05)
- Overall more harms than benefits (global index): HR 1.09 (0.87-1.37)
- Limitations: Subgroup analysis; >130 statistical tests, only 2 statistically significant (6-7 expected by chance alone).
- Subgroup analysis showed decreased mortality and CHD in HT users <10 years post-menopause, but not >10 years
- No evidence that risk of stroke or venous thromboembolism (VTE) lower if HT started <10 years of menopause
- Limitations: Risk reductions driven by above RCT1 and estrogen-only group of WHI (hysterectomy patients), which is not likely generalizable to patients without hysterectomy
- Older systematic review of 30 RCTs found similar effects on mortality for age <60 versus >60.5
- HT is effective for vasomotor and some urogenital symptoms in post-menopausal women.6
- Another Cochrane review7 of 23 RCTs (42,830 patients, mean >60 years) reported small statistically-significant increased risk for cardiovascular events, VTE, stroke, and breast cancer with HT.