The Pharmaceutical Journal
Vol 273 No 7322 p590
23 October 2004

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Analysis suggests HRT does not increase mortality

Hormone replacement therapy has been given a boost following a meta-analysis of pooled data from 30 trials with over 26,000 participants. The data indicate that HRT does not increase total mortality. What is more, in trials where the mean age of women was below 60 years, HRT was associated with a reduction in total mortality of 39 per cent.

Shelley Salpeter, Stanford University medical school, and colleagues examined data from trials that compared HRT with placebo or no treatment and which had lasted for more than six months.

Overall, the odds ratio for total mortality associated with HRT was 0.98 (95 per cent confidence interval, 0.87 to 1.18). The odds ratio for cardiovascular mortality was 1.10 (0.90 to 1.34) and for cancer deaths was 1.03 (0.82 to 1.29). The researchers note that there was no increase in breast cancer deaths in trials that reported cancer-specific mortality.

There were 17 trials with participants having a mean age of under 60 years. The odds ratio for total mortality in this younger group was 0.61 (0.39 to 0.95) with similar figures for cardiovascular and cancer deaths. For the older age group, HRT did not significantly affect cardiovascular or cancer mortality (1.11, 0.91 to 1.36 and 1.07, 0.84 to 1.37, respectively), but was associated with a reduction in mortality from other causes (0.68, 0.56 to 0.91).

“ The results of this analysis indicate that the benefits of HRT may outweigh the risks if treatment is given to younger women, but the risks may outweigh benefits if treatment is started at a later age,” the researchers conclude.

The study is published in the Journal of General Internal Medicine (2004;19:791).
Meanwhile, the American Society for Reproductive Medicine has warned that health professionals need to be better equipped to answer patients’ questions about treatment options for menopausal symptoms. At its 60th annual meeting this week in Philadelphia, the ASRM revealed the results of an online survey of 556 health professionals working in the field of reproductive health.

Nearly all respondents agreed that patients are confused about menopausal treatments and 73 per cent said the number of confused patients was increasing. A similar proportion said they spent most of their time counselling patients about the best treatment option and 84 per cent said they would welcome patient education tools. They also reported a need for a risk/benefit analysis of oestrogen-based hormone replacement therapy.