Discontinuation of hormone therapy linked to increased cardiac mortality

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While the risks and benefits of hormone therapy (HT) are widely debated, the benefits of oestrogen to the heart, appear to be universally accepted. This beneficial relationship between HT and protection against cardiac disease has led to the speculation that withdrawal of HT could result in clinically significant changes in arterial function.

In a new study, scientists evaluated the risk of cardiac and stroke deaths in 432,775 Finnish women who discontinued postmenopausal hormone therapy (HT) over a nine-year period. They found women younger than 60 years at discontinuation of HT showed a significantly increased risk of cardiac death (after ≤5 y of HT exposure, standardised mortality ratio [SMR] 1.52; after >5 y of exposure, SMR 2.08) and stroke death (after ≤5 y of exposure, SMR 2.62; after >5 y of exposure, SMR 3.22) during the first year after treatment as compared with age-matched female background population. This increased risk was not observed in women aged 60 years or older at the time of discontinuation. Increases in risks vanished or markedly decreased when the follow-up time was extended over more than one year.

Writing in Menopause, the authors said further investigation is needed to evaluate causality of the associations.