1 / 12

Cardiovascular Disease in Women Module VI: Update on Menopausal Hormone Therapy and Selective Estrogen Receptor Modulat

Cardiovascular Disease in Women Module VI: Update on Menopausal Hormone Therapy and Selective Estrogen Receptor Modulators (SERMs). Menopausal Hormone Therapy. Observational Data and Assumptions Randomized Trial Data Summary of Current Prescribing Guidelines.

earlene
Download Presentation

Cardiovascular Disease in Women Module VI: Update on Menopausal Hormone Therapy and Selective Estrogen Receptor Modulat

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Cardiovascular Disease in WomenModule VI: Update on Menopausal Hormone Therapy and Selective Estrogen Receptor Modulators (SERMs)

  2. Menopausal Hormone Therapy • Observational Data and Assumptions • Randomized Trial Data • Summary of Current Prescribing Guidelines

  3. “Hormone Replacement Therapy” Risk-Benefit Balance: 1960’s-1990’s Benefits CHD Osteoporosis Vasomotor Symptoms GU Symptoms Skin Preservation Risks Source: Limacher 2002

  4. Postmenopausal Estrogen Therapy • Meta-analysis of observational data: 35% CHD risk reduction in women using hormone therapy • Lipid Effects:  LDL Cholesterol  Lipoprotein (a)  HDL Cholesterol • Metabolic Effects:  Fasting glucose  Fasting insulin levels • Fibrinolytic Effects:  tissue plasminogen activator,  plasminogen-activator inhibitor 1 Sources: Grady 1992, Mendelsohn 1999, Espeland 1998

  5. 15 Estrogen-Progestin Placebo 10 5 1 0 2 3 4 5 HERS: Cumulative Incidence of CHD Events Incidence, % (113) (2763) (2631) (2506) (2392) (1435) Follow-up, yrs (No. at Risk) Source: Adapted from Hulley 1998

  6. Women’s Health Initiative Estrogen and Progestin Arm: Absolute Excess Risk • Excess CHD events: 7/10,000 woman-years • Excess stroke events : 8/10,000 woman-years • Excess pulmonary emboli: 8/10,000 woman-years • Excess invasive breast cancer: 8/10,000 woman-years Source: Writing Group for the WHI Investigators 2002

  7. Women’s Health Initiative Estrogen and Progestin Arm: Absolute Benefits • Fewer colorectal cancers: 6/10,000 woman-years • Fewer hip fractures: 5/10,000 woman-years Source: Writing Group for the WHI Investigators 2002

  8. Women’s Health Initiative: Estrogen Alone in Postmenopausal Women Compared to Placebo: Major Clinical Outcomes * * * P < .05 Favors Treatment Favors Placebo Source: Adapted from WHI Steering Committee 2004

  9. HT Risk-Benefit Balance: 2004 Risks DVT/PE Gallbladder Disease Breast Cancer Breast/Bleeding Side Effects CHD Stroke Dementia Pancreatitis ?Ovarian Cancer Benefits Vasomotor Symptoms Osteoporosis Vaginal Atrophy Colon Cancer Skin Preservation Depression Source: ACOG Task Force for Hormone Therapy 2004

  10. Raloxifene Use for the Heart (RUTH) Trial: Primary and Secondary CVD Outcomes * * p < .05 Source: Adapted from Barrett Connor 2006

  11. Interventions that are not useful/effective and may be harmful for the prevention of heart disease • Hormone therapy and selective estrogen-receptor modulators (SERMs) should not be used for the primary or secondary prevention of CVD Source: Mosca 2007

  12. Menopausal Hormone Therapy, SERMs and CVD: Summary of Major Randomized Trials • Use of estrogen plus progestin associated with a small but significant risk of CHD and stroke • Use of estrogen without progestin associated with a small but significant risk of stroke • Use of all hormone preparations should be limited to short term menopausal symptom relief • Use of a selective estrogen receptor modulator (raloxifene) does not affect risk of CHD or stroke, but is associated with an increased risk of fatal stroke Source: Hulley 1998, Rossouw 2002, Anderson 2004, Barrett-Connor 2006

More Related