Postmenopausal Estrogen and Progestin Use and the Risk of Cardiovascular Disease

doi:10.1056/NEJM199608153350701

A correction has been published: N Engl J Med 1996;335(18):1406.

Volume 335:453-461		August 15, 1996		Number 7

Postmenopausal Estrogen and Progestin Use and the Risk of Cardiovascular Disease

Francine Grodstein, Sc.D., Meir J. Stampfer, M.D., JoAnn E. Manson, M.D., Graham A. Colditz, M.B., B.S., Walter C. Willett, M.D., Bernard Rosner, Ph.D., Frank E. Speizer, M.D., and Charles H. Hennekens, M.D.

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ABSTRACT

Background Estrogen therapy in postmenopausal women has beenassociated with a decreased risk of heart disease. There islittle information, however, about the effect of combined estrogenand progestin therapy on the risk of cardiovascular disease.

Methods We examined the relation between cardiovascular diseaseand postmenopausal hormone therapy during up to 16 years offollow-up in 59,337 women from the Nurses' Health Study, whowere 30 to 55 years of age at base line. Information on hormoneuse was ascertained with biennial questionnaires. From 1976to 1992, we documented 770 cases of myocardial infarction ordeath from coronary disease in this group and 572 strokes. Proportional-hazardsmodels were used to calculate relative risks and 95 percentconfidence intervals, adjusted for confounding variables.

Results We observed a marked decrease in the risk of major coronaryheart disease among women who took estrogen with progestin,as compared with the risk among women who did not use hormones(multivariate adjusted relative risk, 0.39; 95 percent confidenceinterval, 0.19 to 0.78) or estrogen alone (relative risk, 0.60;95 percent confidence interval, 0.43 to 0.83). However, therewas no significant association between stroke and use of combinedhormones (multivariate adjusted relative risk, 1.09; 95 percentconfidence interval, 0.66 to 1.80) or estrogen alone (relativerisk, 1.27; 95 percent confidence interval, 0.95 to 1.69).

Conclusions The addition of progestin does not appear to attenuatethe cardioprotective effects of postmenopausal estrogen therapy.

Source Information

From the Channing Laboratory (F.G., M.J.S., J.E.M., G.A.C., W.C.W., B.R., F.E.S.), the Division of Preventive Medicine (J.E.M., C.H.H.), and the Departments of Medicine and Ambulatory Care and Prevention (C.H.H.), Brigham and Women's Hospital and Harvard Medical School; and the Departments of Epidemiology (F.G., M.J.S., J.E.M., G.A.C., W.C.W.), Nutrition (M.J.S., W.C.W.), and Biostatistics (B.R.), Harvard School of Public Health — all in Boston.

Address reprint requests to Dr. Grodstein at the Channing Laboratory, 180 Longwood Ave., Boston, MA 02115.

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