European Heart Journal Advance Access originally published online on September 30, 2008
European Heart Journal 2008 29(21):2660-2668; doi:10.1093/eurheartj/ehn408
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Hormone therapy and risk of myocardial infarction: a national register study
1 Gynaecological Clinic, Rigshospitalet, 2100 Copenhagen Ø, Denmark
2 Gynaecological Clinic, Hillerød Hospital, 3400 Hillerød, Denmark
3 Research Centre for Prevention and Health, The Capital Region of Denmark, DK-2600 Glostrup, Denmark
4 Department of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
Received 5 April 2008; revised 30 July 2008; accepted 21 August 2008; online publish-ahead-of-print 30 September 2008.
* Corresponding author. Tel: +45 30 31 65 71, Fax: +45 43 23 23 00, Email: loekkegaard{at}dadlnet.dk
Aim: To assess the risk of myocardial infarction (MI) as a result of hormone therapy (HT), with focus on the influence of age, duration of HT, various regimens and routes, progestagen type, and oestrogen dose.
Methods and results: All healthy Danish women (n = 698 098, aged 51–69) were followed during 1995–2001. On the basis of a central prescription registry, daily updated national capture on HT was determined. National Registers identified 4947 MI incidents. Poisson regression analyses estimated rate ratios (RRs). Overall, we found no increased risk [RR 1.03 (95% CI: 0.95–1.11)] of MI with the current HT compared with women who never used HT; age-stratified RR among women aged 51–54, 55–59, 60–64, and 65–69 years were 1.24 (1.02–1.51), 0.96 (0.82–1.12), 1.11 (0.97–1.27), and 0.92 (0.80–1.06), respectively. An increasing risk with longer duration was found for younger women, which was not observed with older age groups. In all age groups, the highest risk of MI was found with continuous HT regimen. No increased risk was found with unopposed oestrogen, cyclic combined therapy, or tibolone. Significantly lower risk was found with dermal route than oral unopposed oestrogen therapy (P = 0.04). No associations were found with progestagen type or oestrogen dose.
Conclusion: In a National cohort study, we found that HT regimen and route of application could modify the influence of HT on the risk of MI.
Key Words: Hormone therapy • Hormone replacement therapy • Myocardial infarction • Coronary heart disease • Ischaemic heart disease • Oestrogen
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