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Effect of hormone replacement therapy on cardiovascular outcomes: a meta-analysis of randomized controlled trials.
PLoS One 2013; 8(5):e62329Plos

Abstract

BACKGROUND

Hormone replacement therapy (HRT) is widely used to controlling menopausal symptoms and prevent adverse cardiovascular events. However, the benefit and risk of HRT on cardiovascular outcomes remains controversial.

METHODOLOGY AND PRINCIPAL FINDINGS

We systematically searched the PubMed, EmBase, and Cochrane Central Register of Controlled Trials databases for obtaining relevant literature. All eligible trials reported on the effects of HRT on cardiovascular outcomes. We did a random effects meta-analysis to obtain summary effect estimates for the clinical outcomes with use of relative risks calculated from the raw data of included trials. Of 1903 identified studies, we included 10 trials reporting data on 38908 postmenopausal women. Overall, we noted that estrogen combined with medroxyprogesterone acetate therapy as compared to placebo had no effect on coronary events (RR, 1.07; 95%CI: 0.91-1.26; P = 0.41), myocardial infarction (RR, 1.09; 95%CI: 0.85-1.41; P = 0.48), stroke (RR, 1.21; 95%CI: 1.00-1.46; P = 0.06), cardiac death (RR, 1.19; 95%CI: 0.91-1.56; P = 0.21), total death (RR, 1.06; 95%CI: 0.81-1.39; P = 0.66), and revascularization (RR, 0.95; 95%CI: 0.83-1.08; P = 0.43). In addition, estrogen therapy alone had no effect on coronary events (RR, 0.93; 95%CI: 0.80-1.08; P = 0.33), myocardial infarction (RR, 0.95; 95%CI: 0.78-1.15; P = 0.57), cardiac death (RR, 0.86; 95%CI: 0.65-1.13; P = 0.27), total mortality (RR, 1.02; 95%CI: 0.89-1.18; P = 0.73), and revascularization (RR, 0.77; 95%CI: 0.45-1.31; P = 0.34), but associated with a 27% increased risk for incident stroke (RR, 1.27; 95%CI: 1.06-1.53; P = 0.01).

CONCLUSION/SIGNIFICANCE

Hormone replacement therapy does not effect on the incidence of coronary events, myocardial infarction, cardiac death, total mortality or revascularization. However, it might contributed an important role on the risk of incident stroke.

Authors+Show Affiliations

Department of Cardiovascular Surgery, Shanghai First People's Hospital affiliated to Shanghai Jiao Tong University, Shanghai, China.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

23667467

Citation

Yang, Dicheng, et al. "Effect of Hormone Replacement Therapy On Cardiovascular Outcomes: a Meta-analysis of Randomized Controlled Trials." PloS One, vol. 8, no. 5, 2013, pp. e62329.
Yang D, Li J, Yuan Z, et al. Effect of hormone replacement therapy on cardiovascular outcomes: a meta-analysis of randomized controlled trials. PLoS ONE. 2013;8(5):e62329.
Yang, D., Li, J., Yuan, Z., & Liu, X. (2013). Effect of hormone replacement therapy on cardiovascular outcomes: a meta-analysis of randomized controlled trials. PloS One, 8(5), pp. e62329. doi:10.1371/journal.pone.0062329.
Yang D, et al. Effect of Hormone Replacement Therapy On Cardiovascular Outcomes: a Meta-analysis of Randomized Controlled Trials. PLoS ONE. 2013;8(5):e62329. PubMed PMID: 23667467.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of hormone replacement therapy on cardiovascular outcomes: a meta-analysis of randomized controlled trials. AU - Yang,Dicheng, AU - Li,Jing, AU - Yuan,Zhongxiang, AU - Liu,Xu, Y1 - 2013/05/08/ PY - 2012/12/19/received PY - 2013/03/20/accepted PY - 2013/5/14/entrez PY - 2013/5/15/pubmed PY - 2013/12/18/medline SP - e62329 EP - e62329 JF - PloS one JO - PLoS ONE VL - 8 IS - 5 N2 - BACKGROUND: Hormone replacement therapy (HRT) is widely used to controlling menopausal symptoms and prevent adverse cardiovascular events. However, the benefit and risk of HRT on cardiovascular outcomes remains controversial. METHODOLOGY AND PRINCIPAL FINDINGS: We systematically searched the PubMed, EmBase, and Cochrane Central Register of Controlled Trials databases for obtaining relevant literature. All eligible trials reported on the effects of HRT on cardiovascular outcomes. We did a random effects meta-analysis to obtain summary effect estimates for the clinical outcomes with use of relative risks calculated from the raw data of included trials. Of 1903 identified studies, we included 10 trials reporting data on 38908 postmenopausal women. Overall, we noted that estrogen combined with medroxyprogesterone acetate therapy as compared to placebo had no effect on coronary events (RR, 1.07; 95%CI: 0.91-1.26; P = 0.41), myocardial infarction (RR, 1.09; 95%CI: 0.85-1.41; P = 0.48), stroke (RR, 1.21; 95%CI: 1.00-1.46; P = 0.06), cardiac death (RR, 1.19; 95%CI: 0.91-1.56; P = 0.21), total death (RR, 1.06; 95%CI: 0.81-1.39; P = 0.66), and revascularization (RR, 0.95; 95%CI: 0.83-1.08; P = 0.43). In addition, estrogen therapy alone had no effect on coronary events (RR, 0.93; 95%CI: 0.80-1.08; P = 0.33), myocardial infarction (RR, 0.95; 95%CI: 0.78-1.15; P = 0.57), cardiac death (RR, 0.86; 95%CI: 0.65-1.13; P = 0.27), total mortality (RR, 1.02; 95%CI: 0.89-1.18; P = 0.73), and revascularization (RR, 0.77; 95%CI: 0.45-1.31; P = 0.34), but associated with a 27% increased risk for incident stroke (RR, 1.27; 95%CI: 1.06-1.53; P = 0.01). CONCLUSION/SIGNIFICANCE: Hormone replacement therapy does not effect on the incidence of coronary events, myocardial infarction, cardiac death, total mortality or revascularization. However, it might contributed an important role on the risk of incident stroke. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/23667467/Effect_of_hormone_replacement_therapy_on_cardiovascular_outcomes:_a_meta_analysis_of_randomized_controlled_trials_ L2 - http://dx.plos.org/10.1371/journal.pone.0062329 DB - PRIME DP - Unbound Medicine ER -