Statin therapy, cardiovascular events, and total mortality in the Heart and estrogen/progestin replacement Study (HERS)

• Published in: Circulation (New York, N.Y.) Vol. 105; no. 25; pp. 2962 - 2967
• Main Authors: HERRINGTON, David M, VITTINGHOFF, Eric, LIN, Feng, FONG, Josephine, HARRIS, Fran, HUNNINGHAKE, Donald, BITTNER, Vera, SCHROTT, Helmut G, BLUMENTHAL, Roger S, LEVY, Robert
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 25-06-2002; American Heart Association, Inc
• Subjects: Aged; Biological and medical sciences; Cardiovascular Diseases - prevention & control; Coronary Disease - drug therapy; Coronary Disease - mortality; Drug Interactions; Estrogen Replacement Therapy; Estrogens, Conjugated (USP) - therapeutic use; Female; Follow-Up Studies; General and cellular metabolism. Vitamins; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Medical sciences; Medroxyprogesterone Acetate - therapeutic use; Myocardial Infarction - epidemiology; Myocardial Infarction - prevention & control; Pharmacology. Drug treatments; Postmenopause; Thromboembolism - epidemiology; Thromboembolism - prevention & control; Human; Replacement therapy; Prognosis; Enzyme; Treatment efficiency; Mortality; Menopause; Estrogen; Enzyme inhibitor; Cardiovascular disease; Exploration; Statin derivative; Chemotherapy; Treatment; Hydroxymethylglutaryl-CoA reductase; Oxidoreductases; Progesterone
• DOI: 10.1161/01.CIR.0000019406.74017.B2
• EISSN: 1524-4539
• ISSN: 0009-7322

Although effects of statins on cardiovascular outcomes are well established in men, fewer data exist for women. Furthermore, the effects of statins plus hormone replacement therapy (HRT) on cardiovascular outcomes are uncertain.
We examined statin use, cardiovascular events, and total mortality in the Heart and Estrogen/progestin Replacement Study (HERS), a randomized clinical trial of estrogen plus progestin versus placebo in postmenopausal women with heart disease (n=2763). A nonrandomized comparison of statin users and nonusers revealed lower rates of the primary outcome, nonfatal myocardial infarction or coronary heart disease death (relative hazard [RH]=0.79, 95% confidence intervals [CI] 0.63 to 0.99, P=0.04), and total mortality (RH=0.67, 95% CI 0.51 to 0.87, P=0.003). Rates of venous thromboembolic events were also lower among statin users (RH=0.45, 95% CI 0.23 to 0.88, P=0.02). HRT resulted in a significant increase in early risk for primary events in women who did not use statins (RH=1.75, 95% CI 1.02 to 3.03, P=0.04) but not in statin users (RH=1.34, 95% CI 0.63 to 2.86, P=0.45). Adjustment for postrandomization statin use showed no effect of HRT on risk for the primary outcome (RH=0.96, 95% CI 0.77 to 1.29; P=0.72).
In HERS, statin use was associated with lower rates of cardiovascular events, venous thromboembolic events, and total mortality. These data provide strong support for statin use in eligible women with coronary disease.