Papworth HRT Atherosclerosis Study
No benefit of transdermal HRT in secondary prevention of ischaemic heart disease.
A study designed to assess the possible benefit of transdermal HRT in women with ischaemic heart disease has recently been reported - BrJOG 2002, 109: 1506-1062. In this prospective, randomised trial, 255 postmenopausal women with proven ischaemic heart disease were randomised to transdermal HRT or control. Women who had previously had a hysterectomy were randomly allocated to an oestrogen patch (delivering 80micrograms oestradiol per day) or to no therapy. Women with an intact uterus received oestrogen only patches (80 micrograms oestradiol per day as above) for the first 14 days, followed by combined patches providing 80 micrograms oestradiol plus 120 micrograms norethisterone per day for 14 days, or no therapy. Follow up was for a mean duration of 30.8 months.
During the first 2 years of follow up, there was a higher, but not statistically significant rate of hospital admission with unstable angina, myocardial infarction or cardiac death in the HRT group.
The HERS trial, reported in 1998, using oral oestrogen plus progestogen, showed similar findings. This Papworth study, using a different route of HRT, provides further evidence that HRT should not be used for secondary prevention of ischaemic heart disease.
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