HRT and vitamins C and E do not improve coronary disease in women

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Q&A

HRT and vitamins C and E do not improve coronary disease in women

J Fam Pract. 2003 February;52(2):94-117

By

Nawal M. Lutfiyya, PhD

Eric Henley, MD, MPH

BACKGROUND: Are HRT and antioxidant vitamins useful for the secondary prevention of coronary events in postmenopausal women? While epidemiological studies have demonstrated a positive association between HRT (estrogen alone or in combination with progestin/progesterone) and cardiovascular health benefits, neither of the 2 randomized controlled studies examining this relationship has demonstrated such benefits.
POPULATION STUDIED: A total of 423 postmenopausal women with coronary disease (documented by angiogram), recruited over 2 years at 7 clinical sites in the US and Canada, were studied. Stringent exclusion criteria included:
STUDY DESIGN AND VALIDITY: Using a double-blind (concealed allocation assignment), 2x2 factoral, randomized control design, study participants were assigned to 4 equally sized treatment groups, stratified by clinical center and previous hysterectomy status. Subjects were given either 400 IU of vitamin E and 400 mg of vitamin C or a matching placebo to be taken twice daily with or without HRT. Women with prior hysterectomy were given 1 tablet of conjugated equine estrogen (0.625 mg/d) or a matching placebo; those with no hysterectomy were given 1 tablet of conjugated equine estrogen (0.625 mg/d) and medroxy-progesterone acetate (2.5 mg/d) or matching placebo.
OUTCOMES MEASURED: The primary outcome was the annualized mean (SD) change in minimum lumen diameter from baseline to concluding angiogram of all qualifying coronary lesions, averaged for each patient. Secondary outcomes measured included all-cause mortality and cardiovascular events.
RESULTS: Neither HRT nor antioxidants provided cardiovascular benefit; in fact, potential harm from their use was suggested. Based on coronary angiographic change, the increased risk associated with HRT was statistically significant (P=.045), and the increased risk associated with antioxidant vitamins was of borderline statistical significance (P=.09). All-cause mortality was significantly higher in women assigned to antioxidant vitamins compared with vitamin placebo (P=.047). There were no significant differences between the 4 groups in cardiovascular events, cancer, or other noncardiovascular events.

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HRT and vitamins C and E do not improve coronary disease in women

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