Danish Findings Show Neither Benefit nor Harm of HRT After Myocardial Infarction

However, population-wide observational data are potentially useful for estimating risk in individual patients.


Debate continues about the cardiovascular benefits or harms of hormone replacement therapy (HT). Despite guideline recommendations to discontinue HT in patients with coronary artery disease, as many as 80% of women taking HT at the time of hospitalization for myocardial infarction (MI) continue HT after discharge. To assess whether continuation or discontinuation of HT after MI affects risk for adverse cardiovascular events, investigators studied Danish nationwide registry data on women hospitalized with MI.

During 1997–2008, 3322 female MI survivors aged 40 or older had HT prescriptions at the index hospitalization. Most used combined systemic estrogen and progestogen (33.1%), vaginal estrogen (29.4%), or systemic estrogen alone (28.7%); only 8.8% used other HT. During 1-year follow-up, 282 (8.5%) women had a reinfarction, 218 (6.6%) died of cardiovascular causes, and 357 (10.7%) died of any cause. No significant difference between women who stopped HT and those who continued it was found in the rate of reinfarction (hazard ratio 0.90; 95% confidence interval, 0.68–1.19), cardiovascular mortality (HR, 1.21; 95% CI, 0.90–1.62), or all-cause mortality (HR, 1.22; 95% CI, 0.97–1.53). Notably, discontinuation versus continuation of vaginal estrogen was associated with a reduced risk for reinfarction (HR, 0.54; 95% CI, 0.34–0.86).


Citation(s):

Bretler D-M et al. Discontinuation of hormone replacement therapy after myocardial infarction and short term risk of adverse cardiovascular events: Nationwide cohort study. BMJ 2012 Mar 27; 344:e1802.