Association between hormone replacement therapy and subsequent arterial and venous vascular events: a meta-analysis

Abstract

AimsRandomized controlled trials (RCTs) have shown that the risk of stroke and venous thromboembolism (VTE) is increased with hormone replacement therapy (HRT); the effect on coronary heart disease (CHD) remains unclear.Methods and resultsRCTs of HRT were identified. Event rates for cerebrovascular disease [stroke, TIA (transient ischaemic attack)], CHD (myocardial infarction, unstable angina, sudden cardiac death), and VTE (pulmonary embolism, deep vein thrombosis) were analysed. Sensitivity analyses were performed by type of HRT (mono vs. dual) and subject age. 31 trials (44 113 subjects) were identified. HRT was associated with increases in stroke (odds ratio, OR, 1.32, 95% confidence intervals, CI, 1.14–1.53) and VTE (OR 2.05, 95% CI 1.44–2.92). In contrast, CHD events were not increased (OR 1.02, 95% CI 0.90–1.11). Ordinal analyses confirmed that stroke severity was increased with HRT (OR 1.31, 95% CI 1.12–1.54). Although most trials included older subjects, age did not significantly affect risk. The addition of progesterone to oestrogen doubled the risk of VTE.ConclusionHRT is associated with an increased risk of stroke, stroke severity, and VTE, but not of CHD events. Although most trials studied older patients, increased risk was not related to age. Combined HRT increases the risk of VTE compared with oestrogen monotherapy.

Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case–control study

“…The latter found a higher mortality rate due to CVD in trans women aged between 40 and 64 years. Oral contraceptive use and hormone replacement therapy have been reported to be associated with an increased risk of CVD (20,21), and our results suggest that this may also be true for cross-sex hormone therapy in trans women.…”

Cardiovascular disease in transsexual persons treated with cross-sex hormones: reversal of the traditional sex difference in cardiovascular disease pattern

“…The observation of increased cardiovascular morbidity and mortality during cross-sex hormone therapy in MtoF subjects is not entirely unexpected in as far as a parallel can be drawn with hormone use in women. The majority of observational studies and randomized controlled trials show an increased risk of venous thrombosis (18,19) and arterial disease (stroke and myocardial infarction) (20,21) among current contraceptive users and older postmenopausal women using hormone replacement therapy. But age might be a significant variable, because use of hormone therapy in younger menopausal women is associated with a decreased cardiovascular morbidity and mortality (22).…”

Pengaruh Pemberian N-Acetylcysteine Oral terhadap High Sensitivity C Reactive Protein (Hs-CRP) pada Pasien Hemodialisis Kronis

“…Disfungsi endotel merupakan titik awal terjadinya aterosklerosis melalui proses inflamasi, prokoagulasi dan proliferasi. 12,15,16 Penggunaan ACE, ARB, simvastatin, vitamin C, asam folat dan aspilet dapat mempengaruhi respon inflamasi pasien dalam mekanisme yang berlainan dari masing-masing obat yang akhirnya dapat berpengaruh terhadap kadar hs-CRP. 17,18 Studi menemukan bahwa N-Acetylcysteine sebagai antioksidan dan anti-inflamasi secara efektif menurunkan kadar IL-6.…”