Format

Send to

Choose Destination
J Steroid Biochem Mol Biol. 2014 Jul;142:68-75. doi: 10.1016/j.jsbmb.2013.06.011. Epub 2013 Jul 9.

Hormone replacement therapy and the association with coronary heart disease and overall mortality: clinical application of the timing hypothesis.

Author information

1
Keck School of Medicine, University of Southern California, 2250 Alcazar Street, CSC 132, Los Angeles, CA 90033, United States. Electronic address: athero@usc.edu.
2
Keck School of Medicine, University of Southern California, 2001 Soto Street, SSB 202Y, Los Angeles, CA 90033, United States. Electronic address: wmack@usc.edu.

Abstract

Conclusions from randomized controlled trial (RCT) data over the past 10 years has spanned from presumed harm to consistency with observational data that hormone replacement therapy (HRT) decreases the risk for coronary heart disease (CHD) as well as overall mortality in women who are recently postmenopausal. Multiple clinical studies including randomized trials and observational studies converge with animal experimentation to show a consistency that HRT decreases CHD risk and overall mortality in primary prevention when HRT is started at the time of or soon after menopause. The totality of data supports the "timing" hypothesis that posits that HRT effects are dependent on when HRT is started in relation to age and/or time-since-menopause. The totality of data shows that HRT decreases CHD and overall morality when started in women who are less than 60 years old and/or less than 10 years postmenopausal, providing a "window-of-opportunity". Further evidence shows that women who start HRT when in their 50s and continued for 5-30 years that there is an increase of 1.5 quality-adjusted life-years (QALYs). Additionally, HRT is highly cost-effective at $2438 per QALY gained. The totality of data converges to show a consistency between randomized trials and observational studies that when started in women at or near menopause and continued long-term, HRT decreases CHD and overall mortality compared with women who do not use HRT. This article is part of a Special Issue entitled 'Menopause'.

KEYWORDS:

Clinical trials; Coronary heart disease; Estrogen; Hormone therapy; Menopause; Mortality; Observational studies; Stroke; Timing hypothesis; Women

PMID:
23851166
DOI:
10.1016/j.jsbmb.2013.06.011
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center