November 16, 2017
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Discontinuation of postmenopausal hormone therapy elevates cardiac, stroke death risk

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In the first year after discontinuation of postmenopausal hormone therapy, the risk for cardiac and stroke death increases, particularly among women aged younger than 60 years, according to findings published in Menopause.

“Associations between the long-term use of postmenopausal hormone therapy and risks of cardiovascular diseases have been studied for decades. The data are not uniform, perhaps partly due to differences in hormone therapy regimens and study populations,” Minttu M. Venetkoski, MD, from the department of obstetrics and gynecology at the University of Helsinki and Helsinki University Hospital, Finland, and colleagues wrote.

Venetkoski and colleagues studied the association between cardiac and stroke death risk and discontinuation of postmenopausal hormone therapy. The researchers used the National Medicine Reimbursement Register to identify 432,775 postmenopausal women from Finland who discontinued systematic hormone therapy between 1994 and 2013. They excluded women who had been diagnosed with cardiac or cerebrovascular events within 1 year prior to discontinuing hormone therapy.

The researchers identified the number of cardiac (n = 5,204) and stroke (n = 3,434) deaths and compared them with those in the age-matched Finnish background female population and those in the age-matched hormone therapy users.

Data showed that during the first year following treatment discontinuation, there was a significantly increased risk for cardiac death after 5 years or less of hormone therapy exposure (standardized mortality ratio [SMR] = 1.52; 95% CI, 1.13-2) and after more than 5 years of exposure (SMR = 2.08; 95% CI, 1.44-2.9) among women who discontinued hormone therapy at age younger than 60 years, compared with the age-matched female background population.

Similarly, there was a significantly increased risk for stroke death after 5 years or less of exposure (SMR = 2.62; 95% CI, 2.07-3.28) and after more than 5 years of exposure (SMR = 3.22; 95% CI, 2.29-4.4).

The elevated risk for cardiac and stroke deaths was greater when compared with hormone therapy users. When follow-up was conducted after 1 year, the increase in risk either disappeared or substantially declined, the researchers noted.

“Discontinuation of postmenopausal hormone therapy may be associated with increased risk of cardiac and stroke death during the first posttreatment year, particularly in women who discontinue hormone therapy before the age of 60 years,” Venetkoski and colleagues concluded.

They added, “The deaths reflect only a minor part of total burden of these diseases because for each woman who dies from cardiac cause or stroke, approximately five to 10 women will survive and continue living with different physical and mental incapacities. Further investigation is required to evaluate causality of the observed associations and to elaborate the possible biological mechanisms of hormone therapy termination-related cardiovascular risks.” – by Alaina Tedesco

Disclosure: Venetkoski reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.