A new randomized Danish study, published online October 9, 2012 in BMJ, showed that hormone-replacement therapy (HRT) in postmenopausal women, with a mean age of 50, significantly reduced the risk of the combined end point of mortality, myocardial infarction, or heart failure.
Healthy 1006 women aged 45 to 58 who were recently postmenopausal or had perimenopausal symptoms were randomized to receive HRT (n=502) or no treatment (n=504).
The participants of this study, who used HRT for more than 10 years, had a 52% reduction in cardiovascular endpoints without significant increase in risk of breast cancer or stroke.
This is considered the longest randomized trial with hard end points. The participants were also followed for a further 6 years after discontinuation of randomized treatment.
In 2002, the Women’s Health Study Initiative (WHI) showed no cardiovascular benefit from HRT and, even an indication that HRT may be harmful. However, subsequent analysis of WHI and data from other studies has suggested that the time at which HRT is first started is the key. The women in the Danish study were 13 years younger, on average, than women in WHI (mean age 63 years). Therefore, it is important to initiate the treatment at menopause and not many years later.