Abstract
Background: We assessed whether postmenopausal hormone therapy (HT) was associated with incident heart failure (HF) and its subtypes and examined whether there was a modifying effect of age on the associations. Methods and Results: Postmenopausal women aged 50–79 enrolled in the Women's Health Initiative HT trials were analyzed. The 16,486 women with a uterus were randomized to receive conjugated equine estrogens (CEE 0.625 mg/day) plus medroxyprogesterone acetate (MPA 2.5 mg/day) or placebo, and 10,739 women with prior hysterectomy were randomized to receive CEE (0.625 mg/day) alone or placebo. Incident HF was defined as the first HF hospitalization. HF with reduced ejection fraction (HFrEF) or preserved EF (HFpEF) was defined as EF < 50% or ≥ 50%. During the intervention phase, median follow-up was 5.6 years in the CEE-plus-MPA trial and 7.2 years in the CEE-alone trial. During the cumulative follow-up of 18.9 years, women randomized to HT vs placebo in the 2 combined trials had incidence rates of 3.90 vs 3.89 per 1000 person-years for total HF; 1.25 vs 1.40 per 1000 person-years for HFrEF, and 1.88 vs 1.79 per 1000 person-years for HFpEF, respectively. There were no significant effects of HT on the risk of total incident HF or its subtypes in either trial, and age at randomization did not significantly modify the results. Conclusions: Postmenopausal HT did not alter the risk of hospitalization for HF or its subtypes during the intervention or cumulative 18.9 years of follow-up, and results did not vary significantly by age at randomization. Trial Registration: clinicaltrials.gov Identifier: NCT0000611 https://clinicaltrials.gov/ct2/show/NCT00000611?cond=women%27s±health±initiative&rank=5
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2-12 |
| Number of pages | 11 |
| Journal | Journal of Cardiac Failure |
| Volume | 26 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2020 |
Funding
The WHI program is supported by contracts from the National Heart, Lung, and Blood Institute and the National Institutes of Health. The authors thank the WHI investigators and staff for their dedication and the study participants for making the program possible. A listing of WHI investigators can be found at http://www.whi.org/researchers/Documents%20%20Write%20a%20Paper/WHI%20Investigator%20Short%20List.pdf . The WHI program is funded by the National Heart, Lung, and Blood Institute, the National Institutes of Health and the US Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HSN268201600002C, HHSN268201600003C, and HHSN268201600004C. Dr L Klein is partially supported by R21AG027471. LL, conceived and designed the study; managed, analyzed, and interpreted data; drafted and revised the manuscript; JEM, conceived and designed the study; interpreted data, and critically reviewed and revised the manuscript; LK, CE, GP, LWM, CUC, PG, DML-J, and JW-W, interpreted data and critically reviewed and revised the manuscript. LL and JEM had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The WHI program is funded by the National Heart, Lung, and Blood Institute, the National Institutes of Health and the US Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HSN268201600002C, HHSN268201600003C, and HHSN268201600004C. Dr L Klein is partially supported by R21AG027471. The Women's Health Initiative investigators and National Heart, Lung, and Blood Institute representatives had a role in the design and conduct of the study; interpretation of the data and data collection; management, analysis, review, or approval of the manuscript; and the decision to submit the manuscript for publication. The opinions expressed in the manuscript are those of the study’ authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute, the National Institutes of Health or the Department of Health and Human Services. The WHI program is supported by contracts from the National Heart, Lung, and Blood Institute and the National Institutes of Health. The authors thank the WHI investigators and staff for their dedication and the study participants for making the program possible. A listing of WHI investigators can be found at http://www.whi.org/researchers/Documents%20%20Write%20a%20Paper/WHI%20Investigator%20Short%20List.pdf. The study was carried out while Dr Longjian Liu was a visiting professor in the Department of Epidemiology, Harvard T.H. Chan School of Public Health. Our thanks go to Professor Albert Hofman, MD PhD, the Chair of theDepartment of Epidemiology, for his tremendous support and encouragement in pursuing this collaborative study. Our thanks also go to Mary B. Robert, at Brown University Center for Primary Care & Prevention, and Mary Pettinger, at the WHI Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, for their support while we worked on the data analysis
Keywords
- Postmenopausal hormone therapy
- estrogen
- heart failure
- progestin
- the WHI HT trials
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine