Postmenopausal Hormone Replacement Therapy for Primary Prevention of Cardiovascular and Cerebrovascular Disease
Prepared by B. L. Abramson, with the Canadian Task Force on Preventive Health Care
These recommendations were finalized by the Task Force in February 2003.
| MANEUVER | EFFECTIVENESS | LEVEL OF EVIDENCE <REF> | RECOMMENDATION |
| Hormone replacement therapy for the primary prevention of cardiac disease and cardiac mortality in peri-menopausal women. | For combined estrogen plus progestin
therapy:
- increased risk of non-fatal MI and coronary death (7 more cases/ 10,000) - increased risk of stroke (8 more cases/ 10,000), venous thromboembolism (18 more cases/ 10,000) Overall incraesed relative risk of 22% of an adverse outcome for cardiovascular disease. |
Level I, II-2 <Cauley et al., 1997; Falkeborn et al., 1992; Falkeborn et al., 1993; Finucane, Madans, Bush, Wolf & Kleinman, 1993; Folsom et al., 1995; Lafferty & Fiske, 1994; Schairer, Adami, Hoover & Persson, 1997> |
There is fair evidence to recommend against the use of HRT for the primary prevention of myocardial infarction and death from cardiovascular disease in peri-menopausal women without established CAD (D recommendation).
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* To maintain heart health, women should be advised to adopt other effective preventive strategies, such as lifestyle changes that include increased exercise, lower fat diets, smoking cessation, and blood pressure assessment and control.
** There is insufficient evidence to make a recommendation on HRT for the primary prevention of stroke and death from CVD. Since stroke is a major cause of morbidity and mortality in Canadian women, other beneficial preventive measures, such as aggressive treatment of hypertension, should be used rather than HRT.