Hormone Replacement Therapy Associated With Lower Coronary Artery Calcium Scores

Hormone replacement therapy in postmenopausal women was associated with lower coronary artery calcium scores as well as lower risk of long-term all-cause mortality.

Hormone replacement therapy (HRT) usage was associated with lower coronary artery calcium (CAC) scores and all-cause mortality, according to data presented at the 66th Annual Scientific Session & Expo of the American College of Cardiology in Washington, DC.

Researchers from Cedars-Sinai Medical Center in Los Angeles, California, evaluated 4286 consecutive asymptomatic postmenopausal women (average age, 62.4) who underwent CAC scanning between 1998 and 2012. The patients were followed up for mortality after CAC testing (8.4±3.6 years; minimum 1 year). In addition, height, weight, blood pressure, and lipid and glucose values were assessed.


The use of HRT in postmenopausal women as a means of cardioprotection has been controversial, the investigators noted.

At the time of the CAC scan, 41% of women reported taking HRT. These patients were younger (70.6 vs 63.5 years; P <.001) and had a lower prevalence of hypertension and diabetes. Although there were no differences in total or low-density lipoprotein cholesterol, the average high-density lipoprotein levels were higher in the HRT group. 

The average CAC score was significantly lower in the group taking HRT (119.2±322.2 vs 72.1±223.3; P <.001) for the entire study population and for each separate age group, divided by 5-year intervals.

After adjustment for age and cardiac risk factors in multiple logistic regression analyses, HRT was associated with a higher prevalence of a CAC score of 0 (hazard ratio [HR]: 1.2; 95% CI, 1.03-1.41; P =.02) and lower prevalence of high CAC scores >399 (HR: 0.63; 95% CI, 0.44-0.88; P =.007). A little more than 6% of patients died during follow-up.

HRT was associated with lower mortality rates (5.8% vs 6.8%), and after adjustment for age, cardiac risk factors, and CAC scores, it was also associated with lower long-term mortality risk (HR: 0.7; 95% CI, 0.49-0.98; P =.043).

In a yet-to-be-published paper, the researchers concluded, “Although at the present time, menopausal HRT is not used for the primary or secondary prevention of coronary heart disease, our current analyses suggest that HRT is associated with reduced cardiovascular disease incidence and extent, with attenuated cardiovascular disease progression, and reduced all-cause mortality rates independent of the CAC levels.”

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Arnson Y, Rozanski A, Gransar H, et al. Hormone replacement therapy is associated with less coronary atherosclerosis and lower mortality. Abstract 1176M-05. Presented at: the 66th Annual Scientific Sessions & Expo of the American College of Cardiology. March 17-19, 2017; Washington, DC.