Update on the Cardiovascular Risks of Hormone Replacement Therapy

Hormone replacement therapy decreases the risk of tinnitus in menopausal women: a nationwide study

The incidence and risk of tinnitus associated with hormone replacement therapy (HRT) in menopausal women have not yet been fully examined. We examined the medical records of menopausal women aged between 45 and 79 years from Taiwan's National Health Insurance Research Database of records between 1 January 2000 and 31 December 2010 to establish matched cohorts (13,920 HRT users and 41,760 nonusers). The incidence of tinnitus in HRT users and nonusers were matched 1:3 based on propensity-score matching over this ten year period. The Cox regression hazard model was used to identify risk factors of tinnitus, and results indicate that a significantly lower percentage of HRT users (P = 0.017) developed tinnitus in comparison with nonusers (0.43%, 60/13, 920 vs. 0.59%, 246/41, 760). Using Cox regressions analysis after adjustments for age and other variables (adjusted hazard ratio: 0.505 (95% confidence interval, 0.342–0.756)), we were also able to show that HRT users appeared to have a reduced risk of developing tinnitus in comparison with nonusers. Based on our observation of the lower incidence of tinnitus among HRT users in this cohort, we speculate that HRT may have provided potential benefits on the management and prevention of tinnitus among menopausal women.

Case report: Limb-threatening femoral vein thrombosis in a healthy carpet fitter: Carpet fitter’s thrombosis

Objective

To report a case of femoral vein thrombosis in a carpet fitter and to highlight this as an occupational hazard.

Method

Case presentation and literature review.

Results

An otherwise fit 21-year-old carpet fitter with no past medical history presented with acute thrombosis of his left common femoral, superficial femoral and great saphenous veins. Attempted catheter directed thrombolysis was unsuccessful. Due to severe pain and the threat of venous gangrene he was treated by emergency surgical thrombectomy with excision of chronic venous scarring and vein-patch repair that led to resolution of his symptoms.

Conclusions

Deep vein thrombosis is typically associated with factors such as increasing age and prolonged periods of immobility; however, certain ‘active’ occupations can increase its risk. Crouched and cramped working conditions including repetitive active movement with flexed hips and knees can predispose to increased risk of venous thromboembolism.

Hormone therapy and risk of myocardial infarction

Evaluation of: Lokkegaard E, Andreasen AH, Jacobsen RK, Nielsen LH, Agger C, Lidegaard O: Hormone therapy and risk of myocardial infarction: a national register study. Eur. Heart J. 29(21), 2660-2668 (2008). In a national register study of healthy women aged 51-69 years in Denmark followed between 1995 and 2001, 4947 incident myocardial infarction cases were identified. Overall, there was no increased risk of myocardial infarction in current hormone therapy users. However, an increased relative risk was observed in younger women (aged 51-54 years). Overall, the highest risk of myocardial infarction was found with continuous hormone therapy. There was no increased risk found with unopposed estrogen, cyclical combined therapy or tibolone. A lower risk was found with dermal route. However, no associations were found with progestogen type or estrogen dose.

Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis

OBJECTIVE

To assess the risk of venous thromboembolism in women using hormone replacement therapy by study design, characteristics of the therapy and venous thromboembolism, and clinical background.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Medline.

STUDIES REVIEWED

Eight observational studies and nine randomised controlled trials.

INCLUSION CRITERIA

Studies on hormone replacement therapy that reported venous thromboembolism. REVIEW MEASURES: Homogeneity between studies was analysed using chi(2) and I(2) statistics. Overall risk of venous thromboembolism was assessed from a fixed effects or random effects model.

RESULTS

Meta-analysis of observational studies showed that oral oestrogen but not transdermal oestrogen increased the risk of venous thromboembolism. Compared with non-users of oestrogen, the odds ratio of first time venous thromboembolism in current users of oral oestrogen was 2.5 (95% confidence interval 1.9 to 3.4) and in current users of transdermal oestrogen was 1.2 (0.9 to 1.7). Past users of oral oestrogen had a similar risk of venous thromboembolism to never users. The risk of venous thromboembolism in women using oral oestrogen was higher in the first year of treatment (4.0, 2.9 to 5.7) compared with treatment for more than one year (2.1, 1.3 to 3.8; P<0.05). No noticeable difference in the risk of venous thromboembolism was observed between unopposed oral oestrogen (2.2, 1.6 to 3.0) and opposed oral oestrogen (2.6, 2.0 to 3.2). Results from nine randomised controlled trials confirmed the increased risk of venous thromboembolism among women using oral oestrogen (2.1, 1.4 to 3.1). The combination of oral oestrogen and thrombogenic mutations or obesity further enhanced the risk of venous thromboembolism, whereas transdermal oestrogen did not seem to confer additional risk in women at high risk of venous thromboembolism.

CONCLUSION

Oral oestrogen increases the risk of venous thromboembolism, especially during the first year of treatment. Transdermal oestrogen may be safer with respect to thrombotic risk. More data are required to investigate differences in risk across the wide variety of hormone regimens, especially the different types of progestogens.