Display options
Cite
Wells G, Herrington DM. The Heart and Estrogen/Progestin Replacement Study: what have we learned and what questions remain?. Drugs Aging. 1999;15(6):419-22doi: 10.2165/00002512-199915060-00001.
Wells, G., & Herrington, D. M. (1999). The Heart and Estrogen/Progestin Replacement Study: what have we learned and what questions remain?. Drugs & aging, 15(6), 419-22. https://doi.org/10.2165/00002512-199915060-00001
Wells, G, and Herrington, D M. "The Heart and Estrogen/Progestin Replacement Study: what have we learned and what questions remain?." Drugs & aging vol. 15,6 (1999): 419-22. doi: https://doi.org/10.2165/00002512-199915060-00001
Wells G, Herrington DM. The Heart and Estrogen/Progestin Replacement Study: what have we learned and what questions remain?. Drugs Aging. 1999 Dec;15(6):419-22. doi: 10.2165/00002512-199915060-00001. PMID: 10641952.
Copy Download .nbib Format: NLM
Share it on

Drugs Aging. 1999 Dec;15(6):419-22. doi: 10.2165/00002512-199915060-00001.

The Heart and Estrogen/Progestin Replacement Study: what have we learned and what questions remain?.

Drugs & aging

G Wells, D M Herrington

Affiliations

  1. Department of Internal Medicine/Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA.

PMID: 10641952 DOI: 10.2165/00002512-199915060-00001

Abstract

The Heart and Estrogen/Progestin Replacement Study (HERS) was the first randomised, double-blind, placebo-controlled study to evaluate the outcome of hormone replacement therapy (HRT) on subsequent cardiac events in postmenopausal women with established coronary heart disease (CHD). Of the 2763 women enrolled, 1380 were randomised to receive 0.625mg of conjugated equine estrogens plus 2.5mg of medroxyprogesterone daily (Prempro) and 1383 were randomised to receive a placebo. The results were surprising: 179 women in the hormone group and 182 women in the placebo group experienced either a nonfatal myocardial infarction or CHD death (relative hazard 0.99, 95% confidence interval 0.81 to 1.22). This occurred despite a net 11% reduction in low density lipoprotein (LDL) and a net 10% increase in high density lipoprotein (HDL) after 1 year of follow-up (p < 0.001 for LDL and HDL). Also, there were no differences between the 2 treatment groups in any secondary cardiovascular outcomes. The overall null effect may have been the result of an unexpected early adverse effect of the HRT regimen that offset a later reduction in risk. Clearly, the use of HRT for secondary prevention of heart disease is more complex than was initially believed. More data are needed from other clinical trials concerning the risks and benefits of HRT to confirm or refute the puzzling HERS results. HERS also underscores the need for trials with clinical end-points to evaluate both the safety and efficacy of drug therapy. Although observational studies are useful, they cannot provide definitive answers regarding treatment recommendations. Until further data are available, clinicians should not use estrogen plus medroxyprogesterone for the sole purpose of secondary prevention of CHD.

References

  1. Ann Intern Med. 1992 Dec 15;117(12):1016-37 - PubMed
  2. Lancet. 1979 Apr 7;1(8119):743-7 - PubMed
  3. Am J Epidemiol. 1997 Feb 1;145(3):269-77 - PubMed
  4. Control Clin Trials. 1998 Feb;19(1):61-109 - PubMed
  5. JAMA. 1998 Aug 19;280(7):605-13 - PubMed
  6. Am J Epidemiol. 1993 Jan 1;137(1):54-63 - PubMed
  7. Br J Obstet Gynaecol. 1992 Oct;99(10):821-8 - PubMed
  8. Am J Cardiol. 1997 Apr 1;79(7):847-50 - PubMed
  9. J Am Coll Cardiol. 1998 Mar 1;31(3):684-91 - PubMed
  10. N Engl J Med. 1981 Sep 10;305(11):612-8 - PubMed
  11. N Engl J Med. 1991 Sep 12;325(11):756-62 - PubMed
  12. Lancet. 1994 Nov 26;344(8935):1453-7 - PubMed
  13. N Engl J Med. 1995 Feb 23;332(8):481-7 - PubMed
  14. JAMA. 1995 Jan 18;273(3):199-208 - PubMed
  15. BMJ. 1997 Jul 19;315(7101):149-53 - PubMed
  16. Contraception. 1997 Sep;56(3):141-6 - PubMed
  17. J Am Coll Cardiol. 1997 Jan;29(1):1-5 - PubMed
  18. J Am Coll Cardiol. 1996 Nov 1;28(5):1111-8 - PubMed
  19. Arterioscler Thromb Vasc Biol. 1997 Jan;17(1):217-21 - PubMed
  20. Am J Cardiol. 1998 Feb 26;81(4A):7B-12B - PubMed
  21. Arch Intern Med. 1990 Dec;150(12 ):2557-62 - PubMed
  22. Arch Intern Med. 1994 Jun 27;154(12):1333-9 - PubMed
  23. Lancet. 1996 Oct 12;348(9033):983-7 - PubMed
  24. Ann Intern Med. 1997 Oct 1;127(7):501-8 - PubMed

Substances

MeSH terms

Publication Types

Grant support