Editorial

Coronary heart disease and estrogen plus progestin treatment: the “burden ” of the evidence Health professionals ’ enthusiasm for the prescribing of estrogens together with progestin in postmenopausal women received a major setback recently. The publication of a randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women 1 has brought to light some new evidence in the subject that is contrary to the previous “consensus”. Growing evidence from observational studies among women receiving estrogens had been indicating some benefits of estrogens in the prevention of coronary heart disease in postmenopausal women. But this large randomized double-blind placebo-controlled trial, which aimed to determine whether estrogen/progestin therapy decreased the risk of coronary heart disease events in women with established coronary disease, showed that estrogens together with progestin have negative effects. The study was done on 2.763 women with coronary disease. The treated group received 0.625 mg of conjugated equine estrogens plus 2.5 mg of medroxyprogesterone acetate daily. The follow-up averaged 4.1 years and the adherence was good. The primary outcomes were non-fatal myocardial infarction or coronary heart disease death. 172 women in the hormone group and 176 in the placebo group had these primary events. This lack of overall effect occurred in spite of an 11 % less low density lipoprotein cholesterol (LDL-c) level and a 10 % greater high density lipoprotein cholesterol (HDL-c) level in the hormone group than in the placebo group (P< 0.001). Furthermore, there was a significant trend of more coronary heart disease events in the first year in the hormone group and fewer in the 3rd and 4th year. There were 34 thromboembolic events in the hormone group and 12 events in the placebo group (relative risk 2.89; 95 % C.I. 1.50 to 5.58). Gallbladder disease was significantly more frequent in the hormone group than in placebo, with 84 versus 62 cases (P = 0.05). The authors concluded that the treatment with oral conjugate equine estrogens plus medroxyprogesterone acetate did not reduce the overall rate of coronary heart disease events in the studied patients and did not recommend the use this treatment for the purpose of secondary prevention of coronary heart disease