The Hormone Replacement Therapy Story Continues
In a report in this week’s issue of the journal Circulation, the use of estrogen plus progestin appeared to be associated with reduced risk of heart attack in diabetic women who had not already had a myocardial infarction (Circulation. 2003;107:43–48).
The lowered risk seemed to be associated with low or medium dosages of estrogen but not a high dose, said the group of researchers led by Assiamira Ferrara, MD, PhD, of the Division of Research at North California Kaiser Permanente in Oakland. The researchers assessed the 3-year risk of myocardial infarction among 24 420 women who had not had a recent one. In the study, the researchers identified 1110 new heart attacks.
Adjusting for cardiovascular risk factors, the researchers discovered that the use of hormone replacement therapy appeared to be associated with a reduced risk of myocardial infarction.
However, among the 580 women in the group who had had a recent myocardial infarction, the use of hormone replacement therapy was associated with an increased risk of heart attack.
In an associated editorial (Circulation. 2003;107:2–4), David M. Herrington, MD, MHS, of the Department of Medicine/Cardiology at Wake Forest University School of Medicine in Winston-Salem, NC, noted that previous studies, primarily the Heart and Estrogen/progestin Replacement Study (HERS) and the Women’s Health Initiative, had demonstrated that there was a higher incidence of myocardial infarction and coronary heart disease death in women who received hormone replacement therapy.
Dr Herrington noted that the findings have raised a number of issues. “One of the most important is the need to understand how it is that results from observational studies and randomized clinical trials of HRT [hormone replacement therapy] could produce such radically different results,” he wrote, noting that the study in the present issue of Circulation is another confounding factor. He ends his discussion of the possible reasons for the discordance by noting, “In short, the final chapter of this fascinating story has not yet been written.”
Statins and Heart Transplantation—A Positive Combination
Starting therapy with simvastatin early after heart transplantation resulted in better 8-year survival rates and lower incidence of transplant vasculopathy without severe adverse effects, according to researchers led by Klaus Wenke, MD, of the Division of Cardiac Surgery at Munich-Bogenhausen University Hospital in Germany, in a report in this week’s issue of Circulation (Circulation. 2003;107:93–97).
The issue of transplant vasculopathy has plagued the long-term success of the organ transfer procedures since the mid-1980s. Recent studies have demonstrated that use of statins in this population can lower cholesterol and reduce the death rate and the development of vasculopathy. In this study, German researchers sought to test the safety of the treatment.
In 1991, clinicians began the prospective, randomized study to compare the use of simvastatin begun on the fourth postoperative day in 35 patients compared with 37 patients who received only dietary therapy. After 4 years, most patients in the two groups received the statins because of the positive findings with regard to mortality and vasculopathy in the simvastatin group.
At 8 years, the survival rate was 88.6% in the simvastatin group versus 59.5% in the control group (which had received the statin for 4 years). The incidence of vasculopathy was 24.4% in the simvastatin group versus 54.7% in the control group. Organ function was the same in the two groups. No adverse events from the therapy were seen at the end of the 8-year period.