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HRT Use May Improve Quality of Life for Some Women with CAD

Women with coronary artery disease generally do not derive quality-of-life benefits from hormone replacement therapy, but women with CAD who get hot flashes can be an exception.

Although attention has very recently shifted away from using hormone replacement therapy (HRT) for cardiovascular reasons, millions of women obviously still take HRT for other indications. Quality of life (QOL) is often important to consider in HRT use, yet HRT's effects on QOL have not been documented well. Various aspects of HRT-related QOL were assessed in the HERS trial, in which 2763 postmenopausal women (mean age, 67) were randomized either to placebo or to estrogen plus progestin for secondary prevention of coronary artery disease (CAD).

During 3 years of follow-up, scores for physical function, mental health, and energy/fatigue declined significantly across patients, regardless of HRT status. In general, QOL scores were lower among women who were older, diabetic, hypertensive, or who had angina or heart failure. HRT recipients, particularly older ones, did fare worse than placebo recipients on physical-function measures, but depressive symptoms were somewhat less common in the overall HRT group than in the placebo group. Where HRT use seemed to make the most difference was among women who had flushing (15.7%): In this subgroup, HRT recipients had better mental health and fewer depressive symptoms than did placebo recipients. Among women without flushing (84.3%), HRT users had worse physical function and more fatigue than placebo recipients did.

Comment: In the HERS trial, a study of postmenopausal women with CAD, most HRT users experienced significant declines in QOL, but a subset of women with vasomotor symptoms fared better on some QOL measures than did placebo recipients. Of course, decision making about HRT should be based on noncoronary benefits and risks, and these mixed QOL data obviously do not change that. As the editorialists note, further studies must still determine HRT's effects on QOL and CAD risk in younger women without CAD.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology April 12, 2002

Citation(s):

Hlatky MA et al. Quality-of-life and depressive symptoms in postmenopausal women after receiving hormone therapy: Results from the Heart and Estrogen/Progestin Replacement Study (HERS) trial. JAMA 2002 Feb 6; 287:591-7.

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• Medline abstract (Free)

Rexrode KM and Manson JE. Postmenopausal hormone therapy and quality of life: No cause for celebration. JAMA 2002 Feb 6; 287:641-2.

• Original article (Subscription may be required)
• Medline abstract (Free)