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Article pour les cliniciens

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Association between estrogen replacement therapy and heart failure in postmenopausal women: A systematic review and meta-analysis.

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• Chen Z
• Wu C
• Huang Z

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Commentaires cliniques (en anglais)

Endocrine

Well written paper but it doesn't add much to what is already known about the subject.

Endocrine

This meta-analysis provides clinically useful information on the potential safety of estrogen replacement therapy in postmenopausal women regarding heart failure events.

Endocrine

This meta-analysis sheds light on therole of estrogen replacement therapy (ERT), which is still controversial. Following its high popularity in 1990s, WHI study findings and guidelines led to a rapid decline of its use. However, there are still discrepancies between findings from RCTs and observational studies. This meta-analysis confirms there is no protective benefit of postmenopausal ERT on heart failure (HF) risk and admission to hospital for HF. The review discusses the “timing hypothesis,” showing a benefit trend with early prescription of estrogens. Interestingly, in populations with coronary artery disease, they did not find any benefits in preventing HF. In my view, besides the proven lack of effect on heart failure, the effect of estrogen replacement therapy on reduction of coronary artery disease and cardiac mortality, particularly in younger women, is still worth discussion.

Family Medicine (FM)/General Practice (GP)

It is reassuring to know that ERT is unlikely to have an impact on heart failure.

Gynecology

With more and more information on non-pharmacological treatments for hot flushes, many move away from conventional hormone therapy. I think many physicians are aware of this.

Gynecology

There is so much confusion surrounding the evidence for menopausal HT and cardiovascular safety. Many clinicians are frightened of HT prescribing, even when clinically appropriate. This restrictive practice leads to harm by pushing patients toward alternative practices that sometimes prescribe toxic doses of hormones in a non-evidence-based manner. This adds to the current body of literature showing that in appropriate patients, HT is safe.