Frequently Asked Questions about Estrogen plus Progestin and coronary heart disease

These questions and answers supplement the August 7, 2003 New England Journal of Medicine publication on E + P and coronary heart disease.
  1. How are the latest results on coronary heart disease (CHD) different from the July 2002 report?
  2. What are the primary findings of this report?
  3. Which women are at particularly high or low risk of CHD on E+P?
  4. What is the conclusion of the study in terms of E+P and CHD?
  5. Do these results apply to women in Estrogen-Alone study?
  6. What type of hormone treatment did women in the E+P study take?
1. How are the latest results on coronary heart disease (CHD) different from the July 2002 report?
Answer: The present report (New England Journal of Medicine, August 7, 2003 issue) provides updated analyses of CHD-related health events through July 7, 2002 (the earlier report included health events through April 2002). It includes a detailed review of individual health events, including CHD-related health problems like heart attack, angina, acute coronary syndrome, and congestive heart failure. It also presents findings for smaller groups of women with different health characteristics.
2. What are the primary findings of this report?
Answer: Estrogen plus progestin (E+P) does not protect the heart and may even increase the risk of CHD in generally healthy postmenopausal women. Overall, there was a 24% higher risk of CHD among women in the E+P study compared to women taking placebo (6 extra cases of CHD per 10,000 women per year). The greater risk of CHD was highest during the first year after starting hormone therapy (an 81% increase). E+P had no major effect on the risk of angina, coronary bypass surgery, angioplasty, or congestive heart failure.
3. Which women are at particularly high or low risk of CHD on E+P?
Answer: Women with higher LDL cholesterol levels at the beginning of the study had a particularly high risk of CHD with E+P, but no other factors significantly changed the risk of CHD while using E+P.
4. What is the conclusion of the study in terms of E+P and CHD?
Answer: E+P should not be started or continued for the prevention of heart disease. Women should consider this information when making decisions about E+P use.
5. Do these results apply to women in Estrogen-Alone study?
Answer: We do not yet know to what extent these findings may apply to Estrogen-Alone study participants. That part of the study (for women who have had a hysterectomy) is continuing as the balance of risks and benefits is not yet clear. This study is scheduled to be complete in 2005.
6. What type of hormone treatment did women in the E+P study take?
Answer: Women randomized (assigned by chance) to active hormones were taking one tablet containing conjugated equine estrogens (0.625 mg) and medroxyprogesterone acetate (2.5 mg) each day (Prempro™). When WHI first began, this was the most commonly prescribed menopausal hormone therapy in the United States for women with a uterus.